bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness about human immunodeficiency virus/acquired immune deficiency syndrome and risk factors among out of school adolescents in an urban city
Authors: Bisht Supriya , Prajapati N C , Kumar Rajesh , Agarwal Renu
Published: June 2020

Background: Adolescence is a complex phase of transition from childhood to adulthood. Present education programs usually overlook the needs of adolescents. Among those who are out of school, lack of appropriate level of education regarding human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) make them more vulnerable. Objective: To find the awareness about HIV/AIDS and risk factor among out of school adolescents. Materials and Methods: In this cross-sectional observational study, 211 adolescentspresently not going to school for ?6 months were interviewed. A simple random sampling was done from different areas such as traffic signals, railway station, and slums. Results: Among studied adolescents, 25% had never been to school, while 44.6% had studied <5th class. Half of them worked outside while a quarter was involved in household work. About 44% of total adolescents had heard aboutHIV/AIDS with 16.3% from the age group 10-14 years and 63.2% from 15 to 19 years group. Awareness about sexual relationships was seen in 67% males and 51% females. Among those aware of physical relations, knowledge about condoms was present in 92% males and 82% females. Among sexually active adolescents (67), 74% males and 28% females were involved in physical relations outside marriage, comprising 38 (18%) of all interviewed, putting them at high-risk behavior. Around 25.8% males and none of the females among them had used condoms. 26 (68.4%) of these “at risk” adolescents had a relationship with consent, whereas 24 (63.2%) had multiple sexual partners. Conclusion: Being out of school, these adolescents have poor educational status. Their knowledge about HIV/AIDS is very poor. Adolescents with better education status, higher age and male gender were more aware regarding various aspects of HIV. Significant proportions among these indulge in high-risk sexual behavior, does not use condoms and have multiple sex partners. Their specific needs should be addressed by the ongoing campaigns and programs against HIV to spread more awareness.
A study of modifiable risk factors for acute lower respiratory tract infections among under five children in a tertiary care hospital in Gulbarga, Karnataka
Authors: Mirji Gangadhar , Shashank K J , Shrikant S W
Published: June 2020

Background: Acute respiratory infection includes any infection of the upper or lower respiratory system, as defined by the International Classification of Diseases. Acute respiratory infection is a leading cause of morbidity and mortality in under-five children in developing countries. Objective: This study was undertaken to identify various modifiable risk factors for acute lower respiratory tract infections (ALRI) in children aged from2 months to 5 years. Methodology: This hospital-based case–control study was conducted at Basaveshwarand Sangameshwar general hospital, Gulbarga over 1½. year 200 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 2 months to 5 years were interrogated for potentially modifiable risk factors as per a predesigned preformed. 200 healthy control children in the same age group were also interrogated. Results: The significant socio-demographic risk factors were incomplete immunization for age, low parental education, low socioeconomic status, and overcrowding (p<0.05 in all). Significant nutritional risk factors includemalnutrition, anemia, and rickets (p<0.05 in all). Significant environmental risk factors were parental smoking, use of biomass fuel, and mud/cow dung flooring (p<0.05 in all). Using multiple logistic regression analysis, the factors which were found to be significantly associated were younger age (p=0.000), anemia (p=0.000), incomplete immunization for age (p=0.002), malnutrition (p=0.00), low literacy level of father (p=0.000), and overcrowding (p=0.000). Conclusion: This study has identified various socio-demographic, nutritional, and environmental modifiable risk factors for ALRI which can be tackled by effective education of the community and appropriate initiatives taken by the government.
A study of prevalence of Mycoplasma pneumoniae pneumonia and validation of Immunoglobulin M for Mycoplasma pneumoniae in the diagnosis of Mycoplasma pneumoniae pneumonia
Authors: Kumar Pragalatha , Patil Alkarani T , Latha F J
Published: June 2020

Background: Mycoplasma pneumoniae pneumonia (MPP) is one of the most common causes of childhood community-acquired pneumonia (CAP) and common cause of mortality and morbidity in young children. Polymerase chain reaction (PCR) is promising with higher specificity and superior sensitivity to that of culture or single point serology. Objective: This study was conducted to estimate the prevalence of MPP, and to compare the efficacy of PCR and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) for the diagnosis of MPP among CAP in children. Materials and Methods: This study was conducted in children between 2 months and 12 years of age admitted with clinical and radiological features of pneumonia. The children were presumed clinically to have MP infection as per IAP guidelines when they had a cough and fever for more than 5 days. A predesigned proforma was used to collect history and clinical examination findings. Routine investigations such as complete blood count, C-reactive protein, chest X-ray, and blood culture were done. Those suspected of infection with MP infection were further subjected to PCR and IgM ELISA. Results: MP(27%) was found to be an important cause of CAP in children between 2 and 8 years. The most common clinical symptoms were cough and fever (100%) followed by myalgia (20.8%), arthralgia (16.6%), and rashes (12.5%). PCR is the rapid reliable diagnostic test with a sensitivity of 100% and specificity of 93%. IgM ELISA is equally effective diagnostic test with sensitivity of 83% and specificity of 100%. Conclusion: MP is an emerging cause of CAP in school going as well as preschool children. Although PCR is an alternative test of culture, use of simple test like IgM ELISA will reduce the cost of investigation and help us in arriving at definitive diagnosis of MP.
Clinical characteristics and laboratory profile of childhood systemic lupus erythematosus in a tertiary care center
Authors: Kumar B M Sunil , Rau A T K , Rao Chandrika
Published: June 2020

Objectives: To study the clinical characteristics and laboratory profile of systemic lupus erythematosus (SLE) in children in a tertiary care center. Methods: Children presenting to our tertiary care center with suspected SLE, fulfilling at least 4 out of 11 American College of Rheumatology (ACR) criteria for the diagnosis of SLE were reviewed retrospectively. The study period was from June 2012 to May 2015. The clinical presentation and laboratory parameters were analyzed. Results: A total of 14 patients fulfilled the ACR criteria; there were 12 girls and 2 boys with a sex ratio of 1:6 favoring girls. The mean age on presentation was 9.8 years with a range of 3-15 years. At presentation, 70% of the children had features not suggestive of SLE. The most common symptom was fever seen in 100% of the patients, followed by hematological abnormalities in 78%, and renal involvement in 57% patients. Arthritis, skin lesions, and pulmonary involvement were seen in 42% of the patients. The gastrointestinal presentation was seen in 21% of the patients. Conclusion: SLE has a varied clinical presentation depending on the predominant organ involved. A high index of suspicion is required for the early diagnosis of SLE in children.
Postnatal growth and short-term complications in very low birth weight neonates receiving total parenteral nutrition
Authors: Purkayastha Jayashree , Soundaram V , Lewis Leslie Edward , Bhat Y Ramesh
Published: June 2020

Objective: To study the postnatal growth and short-term complications in very low birth weight preterm neonates receiving total parenteral nutrition (TPN). Methods: This prospective, observational study was conducted in the neonatal intensive care unit of a tertiary care hospital in South India. All neonates with birth weight <1250 g and <32 weeks of gestation who received TPN and survived at least 7 days were studied prospectively. Amino acid infusion was started at 1 g/kg/day on day 1 and graded up to 4 g/kg/day. Lipids were started on the day 2 of life at 1 g/kg/day and graded up to 3 g/kg/day. Enteral feeds were introduced within3 days of life. TPN was stopped once enteral feeds reached 100 ml/kg/day. Postnatal growth and biochemical and hematological parameters were also monitored. Results: Time to reach full enteral feeds was 11.3±4.5 days, cumulative weight loss proportion (in %) was 8.5±4.7, and number of days to regain birth weight was 11.1±4.5 days. Mean growth velocity (GV) at 30 days of life and 40 weeks of postmenstrual age (PMA) was 16.37±4.8 g/kg/day and 20.03±5.8 g/day, respectively. Mean GV of appropriate for gestational age (AGA) infants was 3.13 g/kg/day, lower compared to small for GA (SGA) infants at 30 days PMA (p=0.01). However, there was no statistical difference in GV between AGA and SGA infants at 40 weeks of PMA. There was no correlationbetween energy intake on the day 7 and weight and head circumference at 40 weeks of PMA. Hyponatremia was observed in 40.6% infants receiving TPN, and there were no other significant complications. Conclusion: Conventional TPN was associated with favorable postnatal growth until 30 days of postnatal life. However, catch-up growth at 40 weeks of PMA was not satisfactory. Mean GV of AGA infants was found to be lower compared to that in SGA infants at 30 days of postnatal life. Besides hyponatremia, there was no major complication due to TPN in this study.
Maternal anthropometry in relation to birth weight of newborn: A prospective hospital based study
Authors: Shrivastava Jyotsna , Agrawal Amit , Giri Ashish
Published: June 2020

Background: Birth weight of neonate is probably the most important factor that affects the future survival and quality of life of the neonates. Objective: To study the maternal anthropometric parameters in relation to birth weight of neonate. Methods: This observational case-control study was conducted in a tertiary care teaching hospital in central India from March 2013 to September 2014. Low birth weight (LBW) neonates (<2.5 kg) and their mothers were taken as cases, and normal birth weight (NBW) neonates (?2.5 kg) and their mothers were taken as controls. Data regarding demographic profile, maternal and neonatal anthropometry, antenatal, and natal events were recorded. Results: Of total 600 subjects, 300 neonates were LBW (cases) and 300 were NBW (controls). Mean birth weight was 2.05±0.252 kg (in cases) and 2.9±0.295 kg (in control). The weight of 59.3% mothers in the case group was below 50 kg (odds ratio [OR] - 3.4) and height was <150 cm (OR - 1.22). Mean maternal body mass index (BMI) in study and control group was 21.73±0.25 and 22.06±0.87, respectively (p<0.0677). BMI ranged from 21.5 to 22 in 85% of NBW and 19% of LBW neonates, and from 22.1 to 22.9 in 81% of LBW and 15% of NBW babies. Mean maternal mid-upper arm circumference (MUAC) in this study and control group were 20±2.13 cm and 25.5±1.36 cm, respectively (p<0.0001). Maternal MUAC was 19-23 cm in 81% of LBW babies and 23-27 cm in mothers of NBW babies (OR - 24). Conclusion: MUAC can be used as an easy cost-effective tool to identify mother at risk of delivering LBW babies so that they can be subjected appropriate care intervention at hospital and home to improve the perinatal outcome.
Cross-sectional study of risk factors associated with neonatal sepsis in a tertiary care teaching hospital
Authors: Kumar G V , Rahman Hareesh Fazulu , - Vatsalakumari , Viswanathakumar H M
Published: June 2020

Background: Neonatal sepsis is the term that has been used to describe the systemic response to infection in newborn infants during the first 28 days of life, which can be affected by multiple risk factors. Objectives: We planned this study is carried out to determine the various risk factors associated with neonatal sepsis in the neonatal intensive care unit (NICU) of this institution. Materials and Methods: This cross-sectional study was carried out in the NICU of Sri Siddhartha Medical College and Hospital, Tumkur, Karnataka, India. All neonates up to the age of 28 days with clinical signs and symptoms, and risk factors of suspected neonatal sepsis wereincluded in the study. Various risk factors, clinical data and investigation findings were collected and recorded on a pretested proforma. Results: Out of 60 newborn babies, 35 were male and 25 were female, and 28 cases were culture positive. Pregnancy-induced hypertension, anemia during pregnancy, and premature rupture of membranes were the most common risk factors observed in our study. The most commonly associated risk factors seen in neonates with culture positive sepsis were low birth weight (89.3%) and prematurity (89.3%) (p=0.0001) followed by respiratory distress syndrome (42.8%). Conclusion: Neonatal sepsis is quiet common, especially when associated with neonatal and maternal risk factors. Prevention of risk factors, early detection of sepsis and accurate treatment go a long way in the good outcome of neonates with sepsis.
Cold abscess of thigh following inadvertent vaccination in an infant
Authors: Verma Sanjay , Didel Siyaram
Published: June 2020

Localized abscess in the same site of bacillus Calmette-Guerin (BCG) vaccine is a known complication. However, the occurrence of such abscess at other sites is uncommon. We, hereby, report a case of 4-month-old female child who developed a swelling at left thigh following intramuscular injection at 6 weeks vaccination. Aspiration cytology of abscess showed granulomatous inflammation and positivity for acid-fast bacilli. The exact etiology for this presentation is unknown; however, wrongful inoculation of the BCG vaccine in place of DPwT vaccine at 6 weeks could be suspected. Mycobacterium should be considered in any unexplained soft tissue abscessin areas of the world where tuberculosis is prevalent.
Progressive pseudo rheumatoid dysplasia mimicking juvenile idiopathic arthritis
Authors: Vajpayee Shailja , Gupta R K
Published: June 2020

Progressive pseudo rheumatoid dysplasia (PPRD) is an autosomal recessive skeletal dysplasia with an underlying mutation in WISP 3 gene. Clinical, it is frequently misdiagnosed as juvenile idiopathic arthritis (JIA), particularly the seronegative polyarticular JIA. It is the characteristic radiological feature which helps in the early recognition of this disease. Here, we report a case of PPRD which has been previously diagnosed as JIA and was on antirheumatoid drugs with no improvement rather a progressive course. Because of its resemblance, PPRD should be kept in mind in the differential diagnosis of inflammatory joint diseases and metabolic bone diseases to prevent inappropriate treatment and unnecessary investigation.
Critical illness?related corticosteroid insufficiency in children: A single center, prospective, cohort study
Authors: Patki Vinayak K , Antin Jennifer V , Agrawal Sanket D
Published: June 2020

Background: Although guidelines for diagnosis and management of critical illness?related corticosteroid insufficiency (CIRCI) in adults are developed, there is a paucity of data on CIRCI in children. Objective: To study the incidence, risk factors, mechanism, and associations of CIRCI in children using adrenocorticotropic hormone (ACTH) stimulation test. Materials and Methods: Single?center prospective cohort study was conducted in eight bedded pediatric intensive care unit of teaching hospital over a period of 1 year. Serum total cortisol concentration was measured in 110 critically ill children before and after stimulation with 250 ?g ACTH. CIRCI was defined by post?ACTH increment in serum cortisol ?9 ?g/dl. Children with and without CIRCI were compared. Results: Incidence of CIRCI was 38.2%. Children with CIRCI had higher median age (34 vs. 18 months), higher pediatric risk of mortality score (17.79±2.60 vs. 16.37±3.68), and significantly higher basal cortisol levels (27.37±11.64 vs. 22.02±7.26) (p=0.004) than those without CIRCI. There was a significantly higher (p=0.000) requirement of catecholamines (2.71±0.457 vs. 2.00±0.792) and higher additional fluid boluses (15.79±4.7 vs. 10.65±4.60) in children with CIRCI. However, duration of catecholamine use was not significantly different between two groups. The presence of CIRCI was not found to be an independent risk factor for mortality. For each additional use of catecholamine, the risk of CIRCI increased to 5.6 times; and for each extra fluid bolus, the risk increased to 1.2 times. Conclusion: CIRCI occurs in a wide spectrum of diseases in critically ill children associated with increased need for catecholamine and fluids. CIRCI is likely to be multifactorial in etiology and associated with high basal cortisol levels.
Procalcitonin as marker of the severity of sepsis in critically ill children
Authors: Deepashree G , Rao Chandrika , Rau A T K
Published: June 2020

Objective: To assess the role of procalcitonin (PCT) in the diagnosis and prognosis in children with sepsis. Design: Prospective, observational study. Setting: Tertiary care center in South India. Participants: Children, 1 month to 15 years of age, admitted with the diagnosis of sepsis excluding children with chronic systemic/inflammatory disease, degenerative neurologic disease, primary/ acquired immune deficiency, on steroids and children who had trauma/burns. Intervention: None. Main Outcome Measures: SerumPCT levels, grades of sepsis and mortality. Results: Respiratory tract infection was the most common source of sepsis (71%). Of the 53 patients studied, PCT was >2 ng/ml in 42 (79.2%) patients. Mean PCT values were 9.63, 17.72, and 84.68 ng/ml in sepsis, severe sepsis, and septic shock, respectively. PCT was found to be 86.36% sensitive, 55.56% specific with a positive predictive value (PPV) of 90.48, and negative predictive value of 45.45. 79.2% of patients in the study were discharged and 18.9% died. PCT levels were high in children who died subsequently. Conclusions: There is a positive association between PCT levels and the severity of sepsis as reflected by high sensitivity and PPV. High PCT levels also indicate increased chances of mortality.
Current antibiogram pattern of Salmonella typhi and paratyphi isolates and response to treatment in a tertiary care centre
Authors: Udayakumar S , Swathi P M , Pushpalatha K , Ravi G S
Published: June 2020

Objective: The objective of this study is to study the current antibiotic sensitivity pattern of Salmonella typhi and paratyphi isolates and the clinical response of children with culture positive enteric fever (EF) to the specific antibiotic used as suggested by the sensitivity pattern. Materials and Methods: This is a retrospective study analyzing the records of 197 children treated for blood culture positive EF during 3 years from January 2013 to December 2015. Antibiogram pattern of S. typhi/paratyphi and response pattern to the antibiotic used as per antibiogram were analyzed. Kirby Bauer’s disc diffusion method was used for antibiotic sensitivity using closed-loop stripping analysis standards. Temperature charts of the patients analyzed for response patternof fever to the antibiotic started. Results: 197 culture positive cases were included in the study (S. typhi=190 and paratyphi=7). Sensitivity pattern to 9 out of 10 antibiotics tested was high and was low only to nalidixic acid (6.3%). There were 184 (93.4%) children whose antibiogram showed high sensitivity to cephalosporins and were treated with intravenous ceftriaxone (Group 1). The majority of children in this group (172/184, 93.5%) became afebrile by 7 days of therapy. 13 (6.6%) children whose antibiogram showed resistance to cephalosporins were treated with intravenous ciprofloxacin (Group 2). 9 of this group became afebrile by 7 days. 12 children from Group 1 and 4 children from Group 2 were considered as either reduced susceptibility or resistance torespective antibiotics and were treated with either azithromycin or piperacillin-tazobactam over the next 5-7 days successfully. Conclusion: Appropriate diagnosis using blood cultures and using 3rd generation cephalosporins as the first line of the drug in treating children with EF can reduce the duration of treatment, promote better compliance, reduce relapse rates, and may help decrease multi-drug resistant S.typhi/partyphi strains in the community..
Knowledge, awareness and practice study for mosquito borne diseases among school children of Malwa region of India
Authors: Taran Shachi Jain , Taran Rakesh , Bhandari Virendra
Published: June 2020

Background: Mosquito borne diseases pose significant burden to the community which can be prevented through right knowledge, attitude and practice of it. Objective: To study the knowledge, awareness and practices of school children about mosquito borne diseases. Materials and Methods: A predesigned, semi structured proforma was filled out from 261 students of 9th to 12th standard of Malwa region. Data was entered in Microsoft excel and percentage of answers were calculated. Results: All students knew something about the mosquito borne diseases. Most of the students (>80%) knew about the malaria and dengue. Very few students were having knowledge that Japanese encephalitis, yellow fever and filariasis are spread though mosquito. 68.2% of students knew fever with chills as symptoms of mosquito borne diseases. More than 85% of students told that mosquito borne diseases can be prevented either through individual protection or through community level protection, supported by government. Conclusion: The awareness regarding malaria was good among students of Malwa region but same was lacking about other mosquito borne diseases.
To assess the thermoregulation of neonates in the postnatal wards of the hospital: A prospective study
Authors: Kalengada Prarthana Karumbaiah , Mangalgi Sharanabasavesha , Pradeep G C M
Published: June 2020

Introduction: Hypothermia is a major cause of neonatal morbidity and mortality. Objective: To know the frequency of hypothermia in the postnatal wards and to know the relation of gestation and birth weight with the temperature of the neonates. Materials and Methods: Rectal temperature of 420 consecutive neonates shifted to postnatal wards of the hospital was measured. The gestation and birth weight of the neonates were recorded. The details were entered, and association of temperature to the birth weight and gestation was calculated. Results: About 70% of the neonates showed mild hypothermia. Gestation and weight of the neonates showed no significant association. Conclusion: The study shows the need to have more vigorous efforts to maintain the temperature in all the neonates in the postnatal wards.
To assess the prevalence and factors determining timely initiation of breastfeeding among the mothers in resettlement colony in Delhi
Authors: Neelima Thakur , Pragti Chhabra , Dadhich J P , Anita Gupta , Vibharika Chandola
Published: June 2020

Background: The initiation of breastfeeding within 1 h of birth has various benefits and has been found to reduce neonatal mortality and morbidity. Objective: This study is designed to assess the prevalence and determinants of timely initiation of breastfeeding among mothers in a resettlement colony of Delhi. Materials and Methods: A community-based cross-sectional study was conducted in a resettlement colony of East Delhi among mothers with infants <6 months of age. Mothers were enrolled from Anganwadi Centers using systematic random sampling, and a questionnaire was used to record information on feeding practices. Chi-square test and multiple logistic regression analysis were performed. Results: The prevalence of the initiation of breastfeeding within 1 h of birth was 51.7%. Using multiple logistic regression analysis, the factors which were found to be significantly associated were type of delivery (p<0.005), place of delivery (p<0.005), and advice on the initiation of breastfeeding at the time of delivery or postnatal period (p<0.005). Conclusions: In this study, the prevalence of the initiation of breastfeeding is better than the national average. It was higher in children born in government health institutions. This study suggests that the importance of the early initiation of breastfeeding should be emphasized during antenatal care visits through trained skilled health professionals in public and private health sector.
Predictors of neonatal mortality referred to a tertiary care teaching institute: A descriptive study
Authors: Sachan Ravi , Singh Aaradhana , Kumar Durgesh , Yadav Rajesh , Singh D K , Shukla K M
Published: June 2020

Objective: To assess the predictors of neonatal mortality transported to our institution from other hospitals. Methods: In this descriptive study, neonates who were delivered outside of the hospital premises and were referred to our tertiary care teaching institute were enrolled in the study and the following information were recorded - gestational ages in completed week, place of birth, stabilization of newborn before and during transportation, and clinical parameter on hospital arrival. Management of neonatal illness was performed as per the standard protocol. Predictors of neonatal mortality were assessed. Results: Out of 245 referred neonates included in the study, 45 expired. Number of babies delivered at home and conducted by unskilled birth attendant was 46 (18.8%) and at private hospitals was 82 (33.5%). Government ambulance facility for neonatal transport was used only in 80 (32.6%). Among the expired neonate, 73.3% of the babies were delivered by unskilled birth attendants (odds ratio [OR]: 16.60, 95% confidence interval [CI]: 4.57-60.19, p=0.0001). Neonatal mortality was significantly less when baby referred or admitted early, i.e. <24 h age at the time of admission (p=0.02) and total duration of transport <1 h (OR: 0.01, 95% CI: 0.001-0.05, p=0.001). Conclusions: Significant predictors of neonatal mortality were birth weight <1.5 kg, gestational age <28 weeks, duration of transport > 1 h, delivery by traditional birth attendants, oxygen saturation <90%, poor perfusion (capillaryrefill time), and cyanosis at the time of admission. The most common cause of mortality was birth asphyxia, followed by sepsis and prematurity.
Utility and safety of laparoscopy for intra-abdominal cysts in small children: Single center experience
Authors: Narendrababu M , Shankar Gowri , Deepak J , Jadhav Vinay , Aihole Jayalaxmi S
Published: June 2020

Objectives: The objective of this study is to study the utility and safety of laparoscopy in the management of intra-abdominal cysts in small children. Materials and Methods: This is a retrospective analysis of patient data that underwent laparoscopy for intra-abdominal cystic lesions. The study period was from March 2010 to April 2015. Patients with adequate follow-up and complete data were included for study. The patients were divided into 3 age groups for analysis of the outcome viz. neonates, infants, and children between 1 and 5 years of age. The data were analyzed for spectrum of lesions managed, surgical procedure performed, operative time, intraoperative events, need for conversion, time to discharge, and the overall outcome. Results: A total of 106/121 patients with adequate follow-up are included for the study and most of the patients (63.6%) belonged to children between 1 to 5 years. Wide spectrums of lesions were managed laparoscopically, and majority 45 (42.4%) had cysts arising from the hepatobiliary system whereas genitourinary system lesions formed 2nd largest group with 21 (19.8%) patients. The procedure was completed laparoscopically in 86.6% (92) of the patients. The morbidity including wound infection, re-exploration, and recurrences, were seen in 5% of patients. The average duration of hospital stay was 4.6 days (range 2-21 days), and the average duration of follow-up was 96 months (range 6-180 months). Conclusion: Laparoscopic surgery is a fascinating technical development for pediatric surgeons. It is applicable for the wide variety of intra-abdominal cystic lesions in children. Excisional surgeries are best performed by laparoscopic technique even in small infants and neonates. In the hands of experienced surgeons, reconstructive surgeries have good outcome with minimal morbidity.
Clinical study of external dysmorphism in congenital heart disease
Authors: Dharmendar V G , - Natesh , Vijayalakshmi I B , Manjunath C N
Published: June 2020

Background: To study the clinical profile and dysmorphism associated in patients presenting to tertiary referral hospital with congenital heart disease (CHD). Materials and Methods: This prospective study was conducted in the Pediatric Cardiology Unit of Sri Jayadeva Institute of Cardiovascular Sciences, Bengaluru, between March 2013 and February 2015. Study subjects include children referred for investigation of suspected heart disease to the Pediatric Cardiology OPD during the study period. Children found to have some type of CHDs were included in the study. All recruited subjects were examined and worked up at outpatient follow-up clinics. Results: A total of 450 subjects were found to have CHDs; out of these, 183 (40.6%) were male and 267 (59.4%) were female. Mean age was 3.34 years (range - 4 days to 24 years) and mean weight was 11.15 kg (range - 2-60 kg). History of maternal diseases and intake of drugs during pregnancy was present in 99 (22%) cases (Odds ratio [OR]=7.4, p=0.0090) and maternal fever in 59 (15%) cases (OR=6.5, p<0.0001). Distribution of CHD cases includes cyanotic CHD in 162 (36%) cases, obstructive lesions in 111 (24.6%), and left to right shunt lesions in 288 (64%) cases. 79.4% cases have shown external dysmorphic features, and main dysmorphic features associated with CHDs were eye anomalies, ear anomalies, upturned nose, clinodactyly, and chest deformity. Conclusion: Eye and ear anomalies, clinodactyly, and chest deformity were the dysmorphic features significantly associated with CHDs. Consanguinity was found to be linked to CHD. Maternal drug intakes and maternal fever during pregnancy also have bearing on CHDs.
Effect of mid-day meal on nutritional status of adolescents: A cross-sectional study from Gujarat
Authors: Patel Prerna P , Patel Pinal A , Chiplonkar Shashi A , Khadilkar Anuradha V , Patel Ashish D
Published: June 2020

Objective: To evaluate the effect of mid-day meal (MDM) on the nutritional status of adolescents and compare it with healthy comparison group. Settings and Design: A cross-sectional study on apparently healthy adolescents (10-14 years) receiving MDM and not receiving MDM (comparison group) was conducted in two cities (Ahmedabad and Patan) of Gujarat, Western India, from January 2012 to March 2014. Materials and Methods: A total of 401 adolescents (200 boys) were selected randomly, using computerized random number generation, from two private and two municipal/government schools. Anthropometric measurements were performed. Height, weight, and body mass index Z scores were computed using ethnic data. Diet was recorded by 24 h recall and nutrient intakes were computed (C-diet V-2.1) as a percentage of the recommended dietary allowance (RDA). Student’s t-test and Chi-square tests were used to compare differences in nutritional status. Results: Percentage of stunting (24% boys and 19% girls) and wasting (17% boys and 18% girls) was significantly higher in adolescents receiving MDM (p<0.001), while the percentage of risk of being overweight, i.e., BMI for age Z (BAZ) >1 or above 85th percentile (18% boys and 12% girls) was predominant in non-MDM receiving adolescents (p<0.001). Compared to non-MDM, MDM receiving adolescents consumed significantly reduced quantity of nutrients (p<0.05). On comparing RDA based on the 24 h dietary recall, it was seen that MDM receiving boys met 60% energy, 78% protein, 50% calcium, and 53% of micronutrient requirements while MDM receiving girls met 59% energy, 67% protein, 44% calcium, and 48% of micronutrient requirements. Non-MDM receiving adolescents had close to RDA or above intake for the most nutrients (p<0.05 for all). Conclusion: Although MDM scheme restricted the percentage of stunting to some extent, the percentage of wasting was critical in terms of public health significance. MDM receiving adolescents were vulnerable to energy, protein, and micronutrient deficiencies.Key words: Adolescents, Nutritional status, Micronutrients, Mid-day
Evaluation of testicular volume in children aged 8-17 years in south India
Authors: Boben Gissy Elizabeth , Umapathy P , Ravichandran Latha , Godfrey D A , Ramani Gokul , Srinivasan V
Published: June 2020

Background: The standard five-stage clinical systems of Tanner and Marshall for assessing pubertal development are limited by observer variations. The measurement of testicular volume, in addition, will make assessments objective. It is important to determine the mean testicular volumes (MTVs) for a given population as reference standards. Aim: To determine the MTVs in children between 8 and 17 years and to compare the MTV with Tanners staging. Methods: A cross-sectional study was conducted on 750 healthy school boys from 2 schools in Chennai between 8 and 17 years of age by a single observer to reduce the observer variation. Tanner’s staging and testicular volume measurement were done using a Prader’s orchidometer. Results: Of the 750 boys studied, the MTV of both the right and left testes was found to increase from 2.47±0.70 cc at 8 years of age, to 3.84±1.91 cc at 12 years, to 15.93±6.65 cc at 17 years of age (p=0.0001). The mean age was found to be increased from 12.69 years at sexual maturity rating (SMR) Stage-2, to 15.66 years at SMR Stage-5. We found a significant positive correlation between SMR and height (p=0.0001), weight (p=0.0001) and body mass index (p=0.0001). The average size of both the right and left testes was found to be increased from 2.86±1.12 cc at SMR Stage-1 to 12.51±4.67 cc at SMR Stage-3 to 18.90±4.64 cc at SMR Stage-5. In our study, 0.5% (n=4) had an MTV of 4 cc at the age of 8, 0.4% (n=3) had an MTV of <4 cc by the age of 14. Conclusion: The measurementof MTV along with Tanner’s SMR staging makes the assessment of male genital development more objective and acts as a measure of testicular growth and spermatogenesis. Generating a baseline data on age appropriate testicular volume in a population or ethnic group is essential to assess sexual developmental disorders among males.
Myocardial performance index in children with ?-thalassemia major
Authors: Suman Rameshwar Lal , Sanadhya Anuradha , Singh Jaskaran , Meena Pradeep
Published: June 2020

Background: Cardiac complications are the major cause of mortality and morbidity in thalassemic children. Iron deposition in myocardium is the key factor leading to poor cardiac functions. Myocardial performance index (MPI) by echocardiography (ECHO) can be used for an early recognition of ventricular dysfunctions. Objectives: To assess the MPI in children with ?-thalassemia major and to establish their relationship with serum ferritin. Methods: Fifty-five children of Thalassemia major in age group of 4-20 years who were on regular blood transfusion and on oral iron chelators from thalassemia unit of tertiary hospital were enrolled.After blood transfusion, serum ferritin estimation was done. Two dimensional ECHO with color Doppler was done to estimate the cardiac functions and then MPI by various parameters was calculated. Results: Out of 55 children, most were in the age group of 4 to 8 years. Mean rate of blood transfusion in subjects was 157.01 ± 21.33 ml/kg/year and mean duration of chelation therapy was 2.34 ± 1.86 years. Mean serum ferritin of subjects was 2130 ± 859.5 ng/ml. Mean ejection fraction was 61 ± 6.2%. Mean MPI of subjects was 0.60 ± 0.14. The MPI was abnormal at all levels of more than 1000 ng/ml serum ferritin (p=0.001). There was a positive correlation between MPI and serum ferritin (Pearson’s bivariate correlation coefficient r=+0.93). Conclusion: In poorlychelated thalassemic children, MPI was abnormally high despite normal ejection fraction, which can be used as an early marker of ventricular dysfunction.
Assessment of speech and language delay among 0-3 years old children attending well-baby clinics using Language Evaluation Scale Trivandrum
Authors: Kondekar Santosh Venketraman , Shree V Sudha
Published: June 2020

Objectives: To assess the prevalence of language delay in children aged 0-3 years and to evaluate the association of sociodemographic, perinatal, and home environment factors with language delay. Materials and Methods: A total of 200 children aged 0-3 years attending the well-baby clinic or the outpatient department were included in the study, with exclusion of children with severe illnesses or those with known developmental delays. The parents of the children were asked to fill a risk factor analysis questionnaire consisting of questions related to the socio-demographic, perinatal factors, and home environment. Children were screened for developmental delay using Language Evaluation Scale Trivandrum for children aged 0-3 years. Results: Prevalence of language delay in our study was 13%. Positive home environment was significantly associated with no language delay in children (p=0.0481); the association was also seen with the parental habit of reading and the happy nature of children (p<0.05). Language delay was more common in the age group of 13-24 months, and other socio-demographic or perinatal factors did not have a statistically significant association with language delay. Conclusion: Positive home environment is significantly associated with less language delay in children aged 0-3 years. Association of different socio-demographic, perinatal, and home  environmental factors with language delay needs to be evaluated with further research.
Prevalence study of common environmental allergens in children with asthma and allergic rhinitis in Kolkata: A hospital-based study
Authors: Dey Sanjukta , Chakraborty Tania
Published: June 2020

Background: Studies evaluating the role of skin prick testing (SPT) as the sole testing technique in children below 12 years of age involving a broader and more relevant group of aero- and food-allergens in this part of India are still lacking. Objectives: To identify the commonly prevalent environmental allergens by SPT in children with asthma as per British Thoracic Society and Scottish Intercollegiate Guidelines Network Criteria and allergic rhinitis (AR) as per British Society for Allergy and Clinical Immunology Criteria attending the OPD of a tertiary care pediatric unit in the eastern part of India. Methods: Testing of inhalant and food allergens by SPT in children from 4 to 12 years age group with asthma and AR satisfying the inclusion criteria. Results: Total 106 children (70 males and 36 females) were included in the study. Study of inhalant allergens in asthmatic patients revealed the highest positivity for house dust mite followed by male cockroach and among food allergens, highest positivity for egg/egg products, followed by milk/milk products. Study of inhalant allergens in asthmatic patients with coexistent AR revealed the highest positivity for house dust mite, cockroach male and female and among food allergens, highest for milk/milk products, egg/egg products, banana, and mustard. Conclusions: In Kolkata, in the eastern part of the country, among the asthmatic children of 4-12 years age group, the most common inhalant allergens were house dust mite and cockroach, whereas the common food allergens identified were milk and milk products, egg and egg products, and mustard.
To compare the effectiveness of oral azithromycin versus intravenous ceftriaxone for treating uncomplicated enteric fever
Authors: Sreenivasa B , Manjunatha B , Joseph Nivil
Published: June 2020

Objectives: To compare the clinical effectiveness of oral azithromycin versus intravenous (IV) ceftriaxone for treating uncomplicated enteric fever. Methods: Children aged 2-17 years with uncomplicated enteric fever and positive blood cultures for Salmonella typhi were included in the study. These were grouped as Group A (50 cases) and Group B (50 cases). Group A was given oral azithromycin 10 mg/kg/day once a day (azithromycin group) and Group B was given IV ceftriaxone 100 mg/kg/day in 2 divided doses (ceftriaxone group) for 6 and 7 days, respectively. Every day the child was examined, and the study results were assigned as a clinical and microbiological cure or failure. Results: A total of 100 patients in sex ratio of 1.2:1 (male:female) with uncomplicated enteric fever were enrolled in the study. Mean duration to become afebrile was less with azithromycin (2.72 days) as compared to ceftriaxone (5.52 days) treatment (p=0.000). 96% of the cases treated with azithromycin attained defervescence by the 5th day of treatment, but only 27% of cases treated with ceftriaxone attained defervescence by the 5th day of treatment. A clinical cure was earlier with azithromycin than with ceftriaxone treatment (p=0.027). Microbiological cure was achieved in 100% and 98% cases treated with azithromycin and ceftriaxone, respectively (p=0.5). Conclusion: Oral azithromycin was more efficacious in the treatment of uncomplicated enteric fever in children as compared to IV ceftriaxone.
Assessment of prevalence of acute respiratory tract infection and risk factors in under five children in anganwadi of Kota city
Authors: Temani Kuldeep , Mayenger Amrita , Bairwa A L
Published: June 2020

Background: Acute respiratory tract infection (ARI) is a major cause of morbidity and mortality in developing countries. Objective: To find out the prevalence and risk factors related to ARI among children between 0 and 5 years attending anganwadi centers in Kota city. Materials and Methods: A community-based, prospective, cross-sectional study was carried out in 14 Integrated Child Development Services center (seven zones) of Kota city covering 406 under five children during March 2015-February 2016. Results: The overall prevalence of ARI was 32% (130/406). Winter season, illiterate mother, >2 under five children at home, overcrowding, smoker in house, family member suffering from cough and cold in last month, smoky chullhas, low birth weight (LBW), partial immunization, inappropriate breastfeeding were significant risk factors for ARI. No associationwas found between prevalence of ARI and age, sex, religion of child, geographic location of house in terms of main road, place of birth (home or hospital), and birth order of the child. Conclusion: The prevalence of ARI was 32%. Significant risk factors were illiterate mother, more than two under five children at home, overcrowding, LBW, partial immunization, lack of exclusive or short duration of exclusive breastfeeding, use of biomass fuel, smoker in house, family history of cough and cold in last month, and kitchen attached to living room.
Improving nursing care in a children’s hospital in rural India
Authors: Leavy Jane D , Janes Julie , Erickson Tiffani A , Folsom Susan M , Koncinsky Jordan B , Schoenhals Sarah , Patel Meghna , Fassl Bernhard
Published: June 2020

Background: Nursing care quality in developing countries is an ongoing challenge leading to poor patient outcomes. The objective of this study is to evaluate changes in nursing performance providing routine cares following a training program in children’s hospital in Mota Fofalia, Gujarat, India. Methods: The main outcome measure was the proportion of newborns with vital signs and weights obtained by nursing staff before and after a training program. The training program consisted of an in-service reinforced by hands-on management of patient care for 2 weeks. Following the training, the nurses were observed for 2 months. Results: Observation of 138 newborn encounters demonstrated a 29.7% improvement in vital sign monitoring and 88.4% in weight monitoring from the 0% baseline. Conclusion: We observed a moderate improvement in measuring vital signs and a substantial improvement in measuring weights in newborns with the training intervention. For further improvement, continued training, and follow-up is indicated.
Outcome of children born to human immunodeficiency virus positive mothers - A retrospective study
Authors: Malpani Preeti , Biswas Manju , Kale Vishal
Published: June 2020

Background: Mother-to-child transmission of human immunodeficiency virus (HIV) is a major route of new infections in children. The use of anti-retroviral therapy and nevirapine to mother-baby pairs has shown to be quite effective in preventing the transmission of virus from mother-to-child. Objectives: To analyze the incidence of HIV transmission in children born to HIV-infected pregnant women and to analyze the outcome of these children. Methods: This retrospective study was conducted in a tertiary care referral hospital of central India for a period of 3 years. Data analysis of the mothers with HIV-positive serology up to their delivery andfollow-up of their babies for 18 months was performed. Perinatal mortality rate (PMR) and neonatal mortality rates (NMRs), mother-to-child transmission rate, and the outcome of their children on the basis of various factors - such as maternal CD4 count, treatment taken, and feeding practices - were analyzed. Results: 161 HIV-positive mothers gave birth to 164 babies (including 1 triplet and 1 twin) during the study period. An incidence of mother-to-child transmission was 8.06% and it was influenced by maternal CD4 count, maternal comorbidities, mode of delivery, and feeding practices. In our study, PMR was 48.78/1000 live births; NMR was 54.87/1000 live births as compared to 25/1000 live births in children born to seronegative mothers. Conclusion: The risk of vertical transmission of HIV from mother-to-baby was 8%. Maternal HIV transmission is the primary means by which infants become infected. Hence, the prevention of maternal HIV transmission is of paramount importance.
Prevalence, clinical, and hematological profile of sickle cell disease in South Rajasthan
Authors: Mandot Sanjay , Ameta Gaurav
Published: June 2020

Objectives: To know the prevalence of sickle cell disease in 0-15 years old children of tribal area and to study its clinical and hematological profile. Materials and Methods: This cross sectional study was conducted between May 2014 and December 2015 in children below 15 years of age from tribal area of Sirohi and Udaipur district in South Rajasthan. Results: A total of 1090 children in tribal area were screened for sickle cell disease. Prevalence of sickle cell disease was found to be 8.53% of which 0.77% children were suffering from sickle cell anemia (HbSS), whereas 7.7% were having sickle cell traits (HbAS). Common morbidities were anemia, pain, infection, and splenomegaly. Conclusion: Sickle cell disease is prevalent in this area. Screening for sickling in this area is suggested for early diagnosis and to promote preventive measures so as to decrease morbidity and mortality.