bluuebunny/crossref_metadata_2025 huggingface dataset:
Bedside reduction of gastroschisis: A feasible option
Authors: Deepak J , Aravind K L , Jadhav Vinay , Shankar Gowri , Narendrababu M
Published: June 2020

Background: Gastroschisis is a common neonatal malformation, with an incidence of 0.4-3 per 10,000 live births worldwide. Objective: This study was planned to assess the feasibility of bedside reduction of gastroschisis (BRG) in the neonatal intensive care unit (NICU) at our institution. Materials and Methods: Retrospective analysis of newborns with gastroschisis managed at our institution between September 2008 and May 2013. Initial bedside reduction in NICU was attempted in all the neonates procedure was done underlocal anesthesia. Incision was extended transversely on the lateral aspect when required. Gradual reduction of bowel loops done with monitoring of parameters. Complete abdominal wall closure in multiple layers/skin closure only was done based on intra-abdominal tension. The final outcome was recorded. Results: During the study period of 60-month, 10 children were treated for gastroschisis at our institution. The sex ratio among them was 8:2 in favor of males. The average age was 23 h (range: 4-72 h). The average birth weight of the babies was 2290 g (range: 1700-2600 g). Six patients were in the high-risk group and 4 in the low-risk group. The BRG was successful in 7 patients and a silo was placed in 3 patients who did not tolerate BRG. General anesthesia was required in 3 patients only for subsequent repair. The overall survival was 70%. Conclusion: BRG is a feasible and safe option. Selective use of silo, gradual staged bowel reduction, and delayed primary closure of the defect can be done on the bedside when attempted BRG is unsuccessful.
Application of pediatric risk of mortality-III score to predict outcome in critically sick children admitted in a tertiary care pediatric unit in a developing country
Authors: Das Krishna Kumar , Kumar Ajay , Paul Premila , Aggarwal K C
Published: June 2020

Objective: The aim of this study is to assess the utilization of the pediatric risk of mortality-(PRISM)-III score to predict mortality in critically sick children and determination of mortality risk factors in a tertiary care pediatric unit. Materials and Methods: In this cross-sectional descriptive study, 100 children admitted during an 18-month period were enrolled in the study. PRISM-III score and mortality risk were calculated. Follow-up was noted as death or survival. Results: Of 100 patients, 27 died and 73 survived. The 47% of the patients were males. The PRISM-III score was 0-9 in 75%, 10-19 in 15% and 20-29 in 8%, ?30 in 2% of patients. PRISM-III score showed an increase of mortality from 8% in 0-9 score patients to 100% in ?20 score. PRISM-III score was significantly associated with study variables such as duration of hospital stay, mental status (Glasgow Coma scale <8), and blood pH <7.28 (p<0001). Conclusion: PRISM-III score showed good predictive value (94.5%) and adequate discriminatory capacity (area under receiver operating characteristics curve 90.8%), and thus constitutes a useful tool for the assessment of prognosis for pediatric patients.
To determine the pattern and severity of cardiac valves involvement in children with rheumatic heart disease
Authors: Goel Manjusha , Agrawal Amit , Kumar Pradip , Dwivedi Rashmi , Yadav B S
Published: June 2020

Background: Rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults and is a major public health problem in developing world. Objectives: To determine the relative frequency and severity of the cardiac valve lesions in children, diagnosed as RHD. Materials and Methods: This prospective observational study was conducted from January 2013 to December 2014 in the Department of Pediatrics and Cardiology of teaching institution. Children less than 15 years of age fulfilling the selection criteria of RHD were evaluated by transthoracic echocardiography for pattern and degree of valvular involvement, according to the American Heart Association/American College of Cardiology guidelines. Results: A total of 45 patients (23 males and 22 females) were studied. The most common age group was 10-12 years, 91.11% cases belonged to lower socio-economic class. The most common lesion was mitral regurgitation (MR) (91.11%) with female predominance (51.22%) followed by atrial regurgitation (AR) (51.11%) with female (56.53%) predominance, mitral stenosis (MS) (26.66%) with male (58.33%) predominance, and tricuspid regurgitation (24.44%) with female (63.64%) predominance. Out of 45 cases of RHD, 29 cases (64.44%) had combined valvular lesions, out of which 14 cases (48.28%) had both MR and AR. Conclusion: RHD is stilla common problem in our country. In our study, the most of the patients had combined valvular lesions. The predominant lesion was MR followed by aortic regurgitation and MS. Regurgitant lesions were seen predominantly in females while stenotic lesions were seen in males. Echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in.
Applicability of pediatric risk of mortality score in predicting mortality in pediatric severe cerebral falciparum malaria cases
Authors: Kondekar Alpana S , Ahmed Maaz , Kondekar Santosh
Published: June 2020

Introduction: Pediatric risk of mortality score (PRISM-3) has been applied in pediatric intensive care settings for varied diagnoses. We planned to study the outcome when PRISM score is applied to a single clinical diagnosis. Objectives: To study the applicability of PRISM score in predicting mortality in pediatric severe cerebral malaria cases. Methodology: This was a retrospective analysis of severe cerebral malaria cases admitted to the pediatric intensive care unit over 3 years from 2009 to 2012 whose peripheral blood smear was positive for Plasmodium falciparum. Cases that presented with single seizure without altered sensorium were excluded. The PRISM scores, predicted mortality and observed mortality, were studied from demographic and clinical data. Results: Of the total 38 cases, 22 (57.8%) cases were females and 16 (42.10%) cases were males. There were 4 (10.52%) infants, 15 (39.4%) children from 1 to 5 years age and 19 (50%) cases were above 5 year age. A total of 14 cases, 36.84% had PRISM score ?10, whereas 16 cases (42.1%) had score 10-20 and 8 cases had scored above 20. Mean predicted mortality was 17.84%, whereas observed mortality was 21.05%. Observed mortality had statistically significant association with PRISM score and predicted mortality rate. Conclusion: PRISM score and the expected mortality rate were good indicators in expecting the outcome of severe cerebral malaria cases. PRISM score can be effectively applied in severe cerebral malaria cases in predicting the outcome.
Circulating 25-hydroxyvitamin D status in apparently healthy adolescents and its association with body mass index in Puducherry population
Authors: Gandhe Mahendra Bhauraoji , Velu V Kuzhandai , Shyamini R Sree , Saha Subiman , Ramesh R , Babu M Sathish
Published: June 2020

Background: Several earlier studies were focused on Vitamin D status and insulin resistance in diabetes mellitus in adult population. However, very few studies have been done among the healthy adolescents associating Vitamin D status with body mass index (BMI) (anthropometric marker of central obesity). Objective: To examine the concentration of 25-hydroxyvitamin D (25[OH]D) in apparently healthy adolescent and its association with BMI in apparently healthy adolescents (12-19 years age group) of Puducherry region. Methods: About 60 apparently healthy adolescents were evaluated for anthropometric, physiological, andbiochemical (fasting insulin and glucose, lipid profile, and 25[OH]D) parameters. Correlation between Vitamin D levels and BMI was calculated. Results: Our study demonstrated a significant low level of 25(OH)D level in overweight (BMI=25-29.9) and obese adolescent (BMI?30) compared to non-obese (BMI<25) group. Pearson’s correlation analysis showed strong negative association between BMI and serum 25(OH)D. Conclusion: Overweight or obese adolescents are more prone to Vitamin D deficiency. Hence, major efforts should be undertaken to tackle Vitamin D deficiency in adolescents such as food fortification and micronutrientsupplementation.
Evaluation of efficacy of topical and systemic antihistaminic drugs in children with allergic rhinitis
Authors: Chaudhary G S , Yadav J S , Singh M , Singh A
Published: June 2020

Objective: To evaluate the efficacy of topical and systemic antihistaminic drugs in children with allergic rhinitis (AR). Methods: This prospective, hospital-based study was conducted on children aged 6-18 years attending pediatric and ENT OPD. The children with a clinical diagnosis of AR were selected for study and were divided into two groups randomly. Group A children received oral second generation antihistamine levocetrizine and Group B children received intranasal antihistaminic drug azelastine. Both groups received medications for 4 weeks. A post therapy response was recorded in the form of symptomatic and histopathological response. Results: There was better symptomatic response for sneezing and rhinorrhea with levocetrizine than azelastine but better response for nasal blockage with azelastine. There was no significant difference in histopathological response of both groups. Conclusion: Levocetrizine was showing better symptomatic response as topical azelastine and also showing better acceptability.
Effect of socio-economic differentials on growth and development of children in five metropolitan cities of India
Authors: Marimuthu Palaniappan , Kanmani T R , Sowmya K
Published: June 2020

Background: Children’s growth and development depend on their parents’ socio-economic status. Adequate nutrition of children influence their anthropometric measures proper growth and development and reduces morbidity and mortality among children. Objective: To understand the growth and development pattern of children dwelling in the slum environment and to compare some of their growth parameters with non-slum children. Methods: This was a record review of National Family Health Survey-3 (NFHS-3) data, freely available from Measure DHS USA. Data for five major metropolitan cities, namely, Delhi, Mumbai, Kolkata, Chennai, and Hyderabad were used for this study. The households classified as slum and non-slum by two agencies, viz., NFHS and census of India were considered for analysis. Variables more relevant as an indicator for the growth and development of children, viz., height, weight, hemoglobin, standard of living index (SLI), age (in months), and place of residence were selected for this study. Place of residence (slum or non-slum) and SLI, which is proxy to socio-economic status, were considered to understand their influence on height, weight, and hemoglobin values of the children. Results: About 75% of the slum dwellers were in low SLI category, and 69% of non-slum residents were in high SLI category. There is a significant difference (p=0.001) between slum and non-slum residence on the proportions of SLI. Multivariate analysis showed that all the variables significantly differ by SLI except age of the children. Conclusion: It is concluded that the observed difference between slum and non-slum children’s height, weight, and hemoglobin are due to differences in SLI. Growth and development of children dwelling in slum or non-slum area depend on the socio-economic status of their parents and not by their place where they are growing.
Determinants of immunization status of children aged 1-5 years attending a tertiary health care facility: A cross-sectional study
Authors: Naaraayan Sridevi A , Sundari S , Subbulakshmi C , Geethalakshmi S , Geetha R , Vengatesan A
Published: June 2020

Background: Childhood immunization is one of the key health interventions, which is useful in decreasing the under-five mortality. There has been a recent decline in immunization coverage rates in India as shown by the National Family Health Survey 4. Objective: This study was undertaken with the objective of determining the socio-economic and demographic risk factors associated with partial immunization of children aged 1-5 years attending a tertiary care center in South India. Materials and Methods: This cross-sectional study was done at the outpatient department of Institute of Child Health and Hospital for Children, Chennai, from May 2015 to October 2015. Children aged 1-5 years attending the outpatient department were included by convenient sampling. A sample size of 1100 was calculated based on a pilot study. After obtaining parental informed consent, data were collected on immunization and socio-demographic factors, namely, gender, place of residence, parental education and occupation, family income, number of children, birth order, place of delivery, and awareness of the type of vaccines to be given. The WHO definitions were used to classify immunization status as full, partial, and delayed immunization. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for partial immunization. Results: Totally, 1104 children were included in the study. 1056 (95.7% [95% confidence interval 94.5-96.9]) were fully immunized, whereas 41 (3.7% [2.59-4.81]) were partially immunized and 7 (0.6% [0.14-1.06]) had delayed immunization. None of the children were totally unimmunized. Univariate analysis identified rural residence, home delivery, having more than 2 children, birth order more than 2, lack of maternal and paternal education beyond primary school level, and lack of awareness on immunization as significant risk factors for partial immunization. After multivariate logistic regression, rural residence, having more than 2 children, and lack of awareness on immunization emerged as independent risk factors for partial immunization. Conclusion: Residing in rural areas, having more than 2 children, and lack of awareness on immunization are significant independent risk factors for a child not being fully immunized.
Trends of formula feeding practices among infant and young children in Bhubaneswar city
Authors: Raj Rishav , Behera B K
Published: June 2020

Objective: To assess the formula feeding practices in Bhubaneswar city and the parameters influencing it. Materials and Methods: A cross-sectional study was conducted from January 1, 2014, to December 31, 2014, in OPD and well-baby clinic of Hi-Tech Medical College, Bhubaneswar and pharmacies in the different Bhubaneswar Municipal Corporation units of this city. 250 mothers having infants and young children were interviewed individually as per pre-designed questionnaire. A separate set of questionnaires for 33 pharmacies were interviewed separately. The data were analyzed by SPSS 16.0 software. Results: About 38% of the mothers were preparing formula with proper dilution. 47% of mothers were adhering to a single brand. Formula sellingconstitutes 15-20% of the average total monthly income of pharmacies. 83% of the formulas were sold without prescription. Pharmacist (30%) and media (20%) were the major influencing factors. Conclusion: Mothers should be clearly explained about the health hazards of formula feeding during antenatal visits and subsequent immunization visits. Infant milk substitute act should include pharmacists, druggists, and chemists.
Comparative study of analgesic effect of breastfeeding and oral sucrose in full-term newborns
Authors: Patel Saurabh Kumar , Gajbhiye Milnd , Singh Jyoti , Singh H P
Published: June 2020

Objective: To study the effects of breastfeeding (BF) and oral sucrose solution on pain due to intramuscular injection in newborns. Design: A prospective, interventional, randomized control study. Setting: Tertiary care hospital. Participants: Randomly selected 150 full-term vaginally delivered healthy newborns. Intervention: A total of 150 newborn infants were randomly divided into three groups. Out of 150 neonates, 50 were included in Group I as control group; 50 were included in Group II as intervention, in which 1 ml of 25% oral sucrose solution was given 2 min before the vaccination; 50 neonates were included in Group III as intervention group, in which BF started 2 min before vaccination and continued until the end of injection. Outcome Measure: The primary outcome of the study was to assess pain by premature infant pain profile (PIPP) score. Secondary outcome measured was changed in heart rate (HR), oxygen saturation (SpO2), and crying time. Results: Mean PIPP scores were lower in the BF group (8.36) than in the sucrose solution group (11.06), and difference was significant (p<0.0001). The mean difference in the increase in HR, decrease in SpO2, and total duration of cry for the breastfeeding group were 13.47, 2.33, and 23.8, respectively, and for sucrose group, they were 16.58, 2.07, and 26.36, respectively (p>0.05). Conclusion: BF and oral sucrose both are equally efficacious in reducing crying time and physiological parameters (HR, SpO2) after intramuscular injection in neonatal period but desaturation was more observed in oral sucrose solution. Further, PIPP score is less in BF group. Thus, BF provides superior analgesia to oral sucrose in term newborns.
Incidence of invasive candidal infection in very low birth weight neonates over a period of 5-year: A single institutional study
Authors: Amboiram Prakash , Balakrishnan Umamaheswari , Ninan Binu , Ramaswamy Saravanan , Ashok C , Kumar K Santosh
Published: June 2020

Background: Fungal infection is one of the important causes of bloodstream infection in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. Objective: To find out the incidence, mortality rate, and clinical spectrum of infants with invasive candidal infection (ICI) among VLBW infants. Materials and Methods: A retrospective descriptive study was conducted over a period of 5-year at a tertiary care hospital. VLBW infants admitted within 24 h of birth were included. The clinical characteristics and the outcome of the infants who developed fungal infection were studied. The end point was either discharge from the unit or death of the infants who developed fungal sepsis. Results: During the study period, there were a total of 641 VLBW infants admitted and 18 neonates had invasive fungal infections (ICI), which accounted to an incidence of 2.8%. The mean birth weight was 1010±289 g, and the mean gestational age (GA) was 28.6±2.93 weeks. End organ involvement was found in 9 (50%) infants with the eye being the most commonly involved organ (39%) followed by renal involvement (22%). Stratified analysis revealed that lower GA and lower birth weight were associated with higher incidence of ICI (p<0.01). Out of 18 isolates that were identified, Candida albicans was the most common organism isolated in 13 (72%) infants. More than ¼ of the cultures (28%) isolated were non-albicans Candida species. The mortality rate among infants with ICI was 11% (2/18). The two infants who died had septicemia caused by C. albicans and multiple (renal and eye) end organ involvement. All-cause mortality in the study group was also 11% (73/641). Conclusion: The incidence of ICI without systemic antifungal prophylaxis was 2.8% and 5.3% in VLBW and ELBW infants, respectively. C. albicans was more common, but the emergence of Candida non-albicans is seen as a growing threat with some of them displaying resistance to azole group of antifungals.
Thrombocytopenia with bleeding manifestations in childhood malaria
Authors: Mohan Kriti , Omar B J , Singh Rupa D , - Aaradhana , Sachan Ravi
Published: June 2020

Background: Thrombocytopenia is frequently found in malaria, but its prognostic value has not been addressed in children. Bleeding with thrombocytopenia in malaria is not so common but can be a cause of mortality if left unattended. Objective: To study the occurrence and severity of thrombocytopenia with bleeding manifestations in children with malaria. Materials and Methods: This cross-sectional study was conducted in a pediatric hospital of north India. All positive cases of malaria <15 years of age admittedto the hospital between January 2008 and December 2013 were included in the study, and data were recorded on pre-designed pro forma. Patients were further assessed for thrombocytopenia and bleeding manifestations. Data were analyzed by Chi-square test and independent sample t-test using SPSS version 16. Results: Total 185 cases were included in the study with a median age of presentation of 4 years. Plasmodium vivax was identified in 142 (77%) patients, whereas Plasmodium falciparum in 31 (17%) and mixed infection in 12 (6%) patients. Thrombocytopenia was observed in 79 (43%) cases, of which 35 (44%) cases had mild, 30 (38%) cases moderate, and 14 (18%) cases had severe thrombocytopenia. Total 10 (5.4%) patients had bleeding manifestations,and all of these had thrombocytopenia. The most common bleeding manifestation was gastrointestinal bleeding presenting as malena. No significant association was found between bleeding and severity of thrombocytopenia (p=0.527) or species of malaria (p=0.682). Furthermore, no significant association was found between severity of malaria and thrombocytopenia (p=0.365). Conclusion: Thrombocytopenia and bleeding were not significantly associated with the type of malaria. In an endemic area, if a child presents with acute fever and thrombocytopenia with or without bleeding manifestation, diagnosis of malaria should be strongly suspected.
Comparison of calcium metabolism in different subgroups of nephrotic syndrome in children
Authors: Mehta Poonam , Nanda Sanjiv
Published: June 2020

Background: Children with nephrotic syndrome are at risk of altered calcium metabolism because of the disease per se as well as steroid therapy even before fall in glomerular filtration rate (GFR). Objective: To compare the pattern of alteration in calcium metabolism in different subgroups (infrequent relapser [IFR], frequent relapser or steroid-dependent nephrotic syndrome [FR/ SDNS], and patients in remission) of nephrotic syndrome in children. Methods: We conducted a cross-sectional study in the Department of Pediatrics, PGIMS, Rohtak. Children between 1 and 8 years of age were divided into three groups, viz., IFR (Group I), FR/SDNS (Group II), and patients in remission (Group III). Serum total calcium, ionized calcium, phosphate, parathormone (PTH), albumin levels, and urinary calcium and phosphate were measured, and X-rays of both lower limbs were done. Results: 10 patients in each group were compared. Serum total calcium, ionic calcium, and urinary calcium levels were decreased in patient with nephrotic syndrome during active disease. No difference was noted in serum phosphate, urinary phosphate, and GFR in all the three groups (p>0.05). Serum calcium and urinary calcium were significantly lower in Group II as compared to Group I (p<0.05),whereas serum PTH levels were significantly higher in Group II as compared to Group I (p<0.05). None of the patients with IFR and in remission had changes of osteopenia while 50% patients with FR/SDNS had features of osteopenia in their X-rays. Conclusion: Hypocalcemia is a common finding in children with nephritic syndrome. These children especially those with FR or SDNS should undergo careful monitoring of calcium, phosphorus, and PTH to prevent bone mineral disease.
Socio-demographic profile of poisoning in children admitted to a tertiary hospital
Authors: Srinivasa B S , Manuprakash S K , Ara Syeda Saltanat , Kumar S R , Prasannakumar D G
Published: June 2020

Background: Childhood poisoning is a significant public health problem and is very important cause of mortality and morbidity in children. The offending substances used vary from place to place. The pattern of poisoning has been changing with new hazards constantly appearing due to the introduction of new drugs and chemicals. Childhood poisoning is usually accidental making poisoning a preventable problem. Objectives: To determine the socio-demographic and clinical profile and outcome of childhood poisoning in a tertiary care hospital. Materials and Methods: This prospective study was done over a period of 2-year in a tertiarycare hospital. We studied children <15 years of age who were admitted to our hospital with a history of poisoning. Children with history of food poisoning, snake bite, scorpion sting, and insect bites were excluded from the study. The demographic profile of patients, various substances of poisoning, mode of poisoning, and outcome of admitted children with poisoning were studied. Results: Among 200 children admitted with the history of poisoning, 126 (63%) were boys and 74 (37%) were girls. The majority of the poisoning were accidental in nature and found to be common in the age group of 1-5 years, children from rural areas, and areof lower socio-economic status. Kerosene poisoning was the most common (35%) agent followed by organophosphorus poisoning (11%). 4 children died due to various complications of poisoning. Conclusion: Common household products were found to be the main source of poisoning in younger age groups from rural background, and the majority was accidental in nature. Educational programs toward creating awareness among public are necessary to reduce the incidence of poisoning in children.
Rectovestibular fistula: Is treatment always required?
Authors: Raghunath B V , Girish M L , Jade Rajashekhar
Published: June 2020

The traditional teaching in the management of rectovestibular fistula involves corrective surgery, either in single or multiple stages. Usually, female children operated for the same are advised cesarean section during childbirth to prevent damage to the neoanus. Herein, we report a story of a 68-year-old woman with untreated rectovestibular fistula and has given birth to five children without any sequalae.
Clinical profile and outcome of H1N1 influenza in children- a tertiary care experience
Authors: Pushpalatha K , Sushma C , Udayakumar S , Mridula A M , Archana V
Published: June 2020

Background: H1N1 influenza pandemic began in Mexico in 2009 and soon spread to the other parts of the globe. The 2009 H1N1 virus contained a unique combination of gene segments that had not previously been identified in humans or animals. Objective: To study the clinical and epidemiological profile and outcome of H1N1 influenza among children admitted to pediatric ward and intensive care unit. Materials and Methods: Prospective data of 82 children with suspected influenza illness were collected, and throat swabs sentfor reverse transcription polymerase chain reaction testing for H1N1. Epidemiological characteristics were analyzed in terms of clinical presentation and outcome. Results: Of the total 82 children with suspected influenza, majority (56.09%) were males, and majority (51.2%) were in the age group of 1-5 years. Throat swab was positive for H1N1 isolate in 22 (26.8%) cases. Clinically, all of them had flu-like illness. All 22 (100%) confirmed H1N1 cases had fever, 21 (95.4%) had cough, 18 (81.8%) had breathlessness, and 15 (68.1%)had running nose. 18 (81.8%) had chest X-ray abnormalities. 1 (4.5%) required mechanical ventilation and 1 (4.5%) succumbed to the illness. Conclusion: Fever, cough, breathlessness, and chest X-ray abnormalities were the most common presentation. A high index of suspicion of swine flu, during epidemics, and early treatment will lessen the mortality rates.
Prevalence of childhood overweight and obesity in rural Pune
Authors: Kurlekar Utkrant , Oka Gauri , Khare Arundhatee
Published: June 2020

Background: Urbanization and mechanization of lifestyle is leading to increase in childhood overweight and obesity in developing countries. Urban Indian studies report a prevalence of 5.5-24% of childhood obesity. The studies representing childhood obesity in rural areas, specifically, rural Pune are lacking. Objective: To determine the prevalence of overweight and obesity in children 10-15 years in rural Pune. Methods: Sociodemographic and anthropometric data were recorded of students from standards V to IX from a rural Pune school. Most recent and revised Indian Academy of Paediatrics (2015) body mass index criteria were applied. Results: Out of 449 children, 239 (53.2%) were boys and 210 (46.7%) were girls (mean age 12.8±1.3 years). The prevalence of overweight was 7.1% (12.5% boys and 8.5% girls) and of obesity was 3.6% (5% in boys and 1.9% in girls). Both overweight and obesity were more prevalent in boys as compared to girls. The proportion of overweight and obese children increased with higher parental educational status, being statistically significant in the case of mother’s educational status (p<0.005). Conclusion: Rural childhood overweight and obesity certainly warrant attention. Strategies for curtailing adult obesity should begin with the prevention and management of childhood obesity.
Study of biochemical and nutritional indicators in severe acute malnutrition: A prospective observational study
Authors: Lakshmi M , Sreenivas S K , Pavitra N A , Nath Sudheendra
Published: June 2020

Background: Malnutrition in children is widely prevalent in developing countries including India. More than 33% of the deaths in 0-5 years are associated with malnutrition. Children with severe acute malnutrition (SAM) are in danger of death from hypoglycemia, hypothermia, fluid overload, electrolyte mismanagement, and undetected infections. Hence, biochemical and nutritional indicators in these children are important for management. Objectives: To study the biochemical and nutritional indicators in children with SAM. Methods: This hospital based prospective study was conducted on children aged 6-59 months admitted at Nutrition Rehabilitation Center attached to a tertiary care teaching institution. 100 consecutive SAM children admitted during 2013-2015 were studied. Children were tested for biochemical and nutritional status like complete blood picture with peripheral smear, liver function tests, renal function tests, serum electrolytes, calcium, phosphorus, and alkaline phosphatase. Results: A total of 100 cases were included, of these 57 were male and female were 43. Mean age of presentation was 18.45±2.37 months. A lack of exclusive breastfeeding was seen in 67% of these children and in 78% children complimentary feeds were initiated either early or later than 6 months. Hypoglycemia was seen in 15% cases, hypokalemia in 22%, and hypocalcemia in 35% of cases. Hyponatremia was seen in 14% and hypernatremia in 19% of the children. The most common type of anemia was microcytic hypochromic type (55%). Conclusion: The observations in this study confirm a significant association between SAM and faulty feeding and early introduction of complementary feeds. It was observed that these children have significant alterations in nutritional indicators at admission.
Clinico-biochemical profile and etiology of acute viral hepatitis in hospitalized children: A study from Eastern India
Authors: Behera Manas Ranjan , Patnaik Lipilekha
Published: June 2020

Background: Acute viral hepatitis (AVH) in children continues to be a major public health problem in India. Objective: To identify the etiology, and to assess the clinical and biochemical profile, complications and outcome of AVH in children. Materials and Methods: A total of 76 children with the clinical diagnosis of AVH were included in this record based retrospective study from January 2014 to August 2016. Data on clinical characteristics, laboratory parameters, immediate outcome, and treatment received were obtained, and analysis was performed. Results: Specific etiological agents were identified in 84.2% children. Out of these, 93.7% were due to a single virus, whereas 6.3% were due to mixed infection. Hepatitis A virus (HAV) was found to be the sole infecting agent in 75% children. Hepatitis B virus (HBV) and hepatitis E virus (HEV) were found in 12.5% and 6.2% children, respectively. Mixed infection was seen in the form of HAV and HEV in 3.1%, and HAV and HBV in 3.1%. The mean age of children with hepatitis A was 8.29±2.74 years, with 70.8% boys and 29.2% girls. Common clinical features were jaundice (95.8%), loss of appetite (95.8%), tender hepatomegaly (68.8%), fever (50%), vomiting (50%), pain abdomen (33.3%), splenomegaly (31.2%), itching (27.1%), bleeding (2.1%), and seizure (2.1%). Acute liver failure was seen in 4.1% and 2% of admitted children died. The mean age of presentation of AVH due to HBV and HEV were 10.7±2.6 years and 10±2.2 years, respectively. Clinical features were similar without any complications or mortality. Significant elevations in hepatic enzymes were seen in mixed infection due to HAV and HEV (p<0.05). Conclusion: HAV is the primary cause of morbidity and mortality due to AVH in this region. HBV and HEV infection may present with similar clinical features, and serological testing must be done to identify the cause.
A hospital-based cross-sectional study on congenital anomalies in newborn babies of Uttarakhand
Authors: Shirke Rupali , Rawat Anil , Chander Vipan , Gupta Alpa
Published: June 2020

Background: Congenital anomalies make an important contribution to infant mortality. They remain a leading cause of death in many countries of the world. The prevalence and pattern of presentation vary from place to place. Objective: The aims and objectives of this study were to determine the prevalence of congenital abnormalities among babies (inborn and outborn) admitted at the Himalayan Hospital, Dehradun, Uttarakhand, India. Materials and Methods: A cross-sectional retrospective study was conducted in a Medical College Hospital in Uttarakhand. The case files of these babies were retrieved from the hospital records department and examined individually by the investigators. Data collection was done with structured forms designed for the study. Result: Among total 2242 neonates included in the study, the prevalence of congenital malformations was 8.3%. Central nervous system and cardiovascular, musculoskeletal, and genitourinary systems were found to be most commonly involved. Conclusion: The present study provides us an idea regarding prevalence of cases of congenital malformations and factors affecting it. In Indian environment, this study helps us to know the pattern of congenital malformation in this part of the country.
Medical management of primary vesicoureteric reflux: A changing trend: Single institute experience with 45 patients (77 renal units) over 2 years
Authors: Murali G S , Jadhav Vinay , Babu Narendra
Published: June 2020

Background: The management of vesicoureteric reflux (VUR) has undergone a radical change from initial ureteric reimplantation to a more conservative approach. Several studies have demonstrated the validity of this concept by evaluating the role of antibiotic prophylaxis. Recent randomized trials have shown no proven benefits of long-term antibiotic prophylaxis. Objective: The objective of this article is to review the outcome of conservative management of VUR with antibiotic prophylaxis over a period of 2-year. Materials and Methods: A prospective observational study for 2 years was performed in children with primary reflux. They were given continuous antibiotic prophylaxis and regularly followed up every 3 months. Relevant investigations were performed at every follow-up including monitoring of growth parameters. Outcome in terms of recurrent urinary tract infection (UTI) episodes, resolution of VUR, need for definitive surgery were analyzed. Results: Out of initial 48 patients enrolled in the study, three patients were lost for follow-up. Out of 45 patients (77 renal units), most of the patients had Grade III and IV reflux. Scarring was seen predominantly in Grade IV reflux (62.5%). At the end of 2 years, no units demonstrated Grade I reflux. Grade II reflux persisted in 16.67%. Grade III reflux persisted in 23.68%, while Grade IV reflux persisted in 62.5%. Most of the fresh UTI episodes occurred in Grade III and IV VUR patients. Fresh renal scars were seen mostly in Grade IV group. One patient underwent ureteric reimplantation due to fresh renal scar and persistent reflux. Conclusions: Conservative management of VUR with antibiotic prophylaxis appears to be a suitable option without adverse outcomes. In the current scenario, surgery has a minor role to play in the treatment of VUR..
A rare presentation of shingles (herpes zoster) in an infant
Authors: Nair P M C , James Jemila , Soumya S
Published: June 2020

Herpes zoster (HZ) in children is very rare. We report a case of HZ in an infant which responded well to the treatment. HZ should also be considered in an infant with vesiculo-bullous lesion in a dermatomal distribution.
Factor XII deficiency - A rare coagulation disorder
Authors: Kumar Rajesh , Gupta Ashok , Mathur Priyanshu , Garg Manisha
Published: June 2020

Severe coagulation factor XII (FXII) deficiency is a very rare, mysterious, and not well-known inherited condition. Unlike other coagulation factor deficiencies, it is usually asymptomatic in most of the cases. Congenital FXII deficiency is the most common cause of an isolated prolongation of the activated partial thromboplastin time in a non-bleeding child or adult; consequently, most patients are detected during a routine pre-operative coagulation study. Surprisingly, it does not lead to abnormal bleeding, but some cases of severe FXII deficiency experiences thrombotic events in their lifetime. There are only a few reports of FXII deficiency in literature. We are reporting a case of congenital FXII deficiency in a 7-month-old child.
Recurrent varicella complicated with staphylococcal scalded skin syndrome in an immunocompromised child
Authors: Singh Amitabh , Mandal Anirban , Seth Rachna , Sheriff Abraar
Published: June 2020

Immunocompromised children are at increased risk of recurrence and reactivation of varicella and its various complications. Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis caused by toxicogenic strains of Staphylococcus aureus. Recurrent varicella lesions can predispose to S. aureus infection, and in the immunocompromised patients, SSSS can rapidly lead to multi-organ failure and death. A 3-year-old male child, on immunosuppressive therapy for acute lymphoblastic leukemia, presented with recurrent varicella infection. After initial improvement, there was deterioration due to the development of secondary bacterial infection and SSSS. He also developed septic shock and disseminated intravascular coagulation. The child recovered with antimicrobial therapy combined with aggressive supportive care. SSSS may present as a complication of varicella infection and is of special importance in immunocompromised. Even with such a rare combination of lethal conditions in the background of immunosuppression, where both diagnosis and treatment is a great challenge, early institution of appropriate therapy may lead to successful outcome.
Relationship between attitude, subjective norm, and perceived behavioural control of learning practices among boarding school students
Authors: Norlia Norlia , Mastura Mastura
Published: June 2020

This study was conducted based on the Theory of Planned Behaviour by Ajzen (1991) aimed at identifying the relationship between attitude, subjective norm and perceived behavioural control to learning practices among students of Boarding Schools (SBP). This study uses a correlational research design involving a sample of 200 low-achieving Form Four students from four SBPs in Johor selected through purposeful random sampling. A Learning Practice Questionnaire by Norlia and Faizah (2016) with values of item (0.98) and individual (0.88) reliability based on RASCH analysis was used to collect the data. The result of the inferential statistical analysis using Pearson correlation shows that there is a significant positive relationship between attitude and subjective norms learning practices (r = 0.44, p
Forest-friendly pedagogy (PeRIMBA) at indigenous school : risk and risk perceptions
Authors: Haron Mohd. Najib , Kasim Rozilah , Wahab Nur Bahiyah Abdul , Yasin Sharifah Nurulhuda Tuan Mohd , Kusin Siti Aminah
Published: June 2020

The Forest-friendly pedagogy (PeRIMBA) refers to the implementation of outdoor learning session by using forest elements as the learning aid and site. There are four basic principles of PeRIMBA which known as supportive environment, task divided into small portions, the usage of natural surroundings and the involvement of all the senses. The implementation of PeRIMBA introduces a risk-taking approach that will offer the opportunities for teachers and students to engage in risky activities during learning session. This risky activity may seem daunting but if the risks are well managed, the learning sessions will be meaningful. In promoting meaningful learning especially to the indigenous school, Malaysia Ministry of Education support and highlight two intervention action plan that promote flexible classroom and fun learning. Flexible curriculum delivery is not dependent on classroom learning only and fun learning promotes the integration and application of forest elements. However, this intervention action plan needs further research and study especially in the field of risk. The emergence of a social science perspective in the field of risk research has opened up new perspectives to define, measure, and explain the concept of risk. Some of the new risk components proposed in social science studies such as shock, threat, danger, lack of control, and uncertainty. Moreover, the fear and unknown factors are components that influence the perceptions of risk. The input on risk and risk perception will be an added value to teachers to implement PeRIMBA in their teaching and learning sessions. These concepts then lead to risk perception that, in turn, influenced risk assessment and risk management.
Nurturing the culture of student participation through online reflection using the QR code system
Authors: Yunus Mohd Fauzi Mohd , Main Aspalilla
Published: June 2020

Participation of student in reflection shows an important role in improving learning strategies. However, the common reflection practice focuses only on self-reflection and it becomes unauthentic. This innovation therefore attempted to prepare the platform for student’s reflection towards the teaching and learning activities in class using online reflection system. Hence an online reflection system based on QR code was developed to reflect this scenario. The code successfully accesses the system and allow the written reflection. Testing result shows the 100% efficiency of QR code recognition and excellence result for inter-rater reliability analysis by experts respectively.
Bitcoin ve Türevi Varlıkların Muhasebeleştirilmesine İlişkin Bir Değerlendirme
Authors: GÜL Hasan
Published: June 2020

Blok zincir (Blockchain) teknolojisinin bir ürünü olarak ortaya çıkan Bitcoin ve türevi kripto paralar son on yılın en önemli ekonomik yeniliğidir. Bitcoin, eşler arası veri paylaşım ağını (Peer-to-Peer) temel alan, merkezi bir otorite tarafından kontrol edilmeyen (decentralized), kamuya açık hesap kaydı tutma özelliğine sahip (PublicLedger), temelde online ödeme yapmayı sağlayan sanal bir para birimidir. Bitcoin, kripto paraların ekonomik olarak tanınmasında temel teşkil etmiştir. Bununla birlikte günümüzde genel veya özel fonksiyonlu pek çok Bitcoin türevi (Altcoin) kripto para birimi geliştirilmiştir. Kripto paralar her geçen gün daha fazla sayıda ticari işlemde kullanılmaya başlanmıştır. Kripto paralarla yapılan işlemlerin nasıl muhasebeleştirileceğine ilişkin henüz belirgin bir düzenleme bulunmaması farklı yaklaşımları da beraberinde getirmektedir. Bu çalışmanın amacı, mevcut yaklaşımlar ışığında kripto paraların nasıl muhasebeleştirilebileceğini tartışmaktır.
Sosyal Etki ve Örgütsel Adalet Algısı İlişkisinde Duygusal Bulaşıcılığın Düzenleyici Rolü
Authors: ZEYNEL Esra , KÖKSAL Kemal
Published: June 2020

Örgütsel davranış açısından önemli sonuçları ortaya çıkaran örgütsel adalet kavramının oluşmasında etkili olan faktörlerin belirlenmesi, işyeri tutum ve davranışlarının daha etkin yönetilmesini sağlayacaktır. Bu araştırmada, sosyal etkinin örgütsel adalet algısına etkisi ve bu ilişkide duygusal bulaşma düzeyinin düzenleyici rolü incelenmiştir. Veriler, kolayda örnekleme ve yüz yüze anket metodu ile akademisyenlerden toplanmıştır. Veriler SPSS ve AMOS programları kullanılarak analiz edilmiştir. Ölçekler geçerliliğini test etmek için doğrulayıcı faktör analizi, değişkenler arası ilişkileri incelemek için ise regresyon analizi kullanılmıştır. Analiz sonucunda, sosyal etkiyi kabullenmenin örgütsel adaleti anlamlı bir şekilde yordadığı ve duygusal bulaşıcılığın bu ilişkide düzenleyici rolünün olduğu tespit edilmiştir. Araştırmacı ve uygulayıcılar için önerilerde bulunulmuştur.
Küreselleşme, Ulus-Devlet Egemenliği ve Ulusal Güvenlik
Authors: POLAT Doğan Şafak
Published: June 2020

Küreselleşme kavramı, yaşamların giderek çok uzaklarda alınan kararlar ve gerçekleşen olaylar tarafından biçimlendirildiği karmaşık karşılıklı ilişkilerin ortaya çıkışını ifade eder. Küreselleşme sürecinde en dikkat çekici değişim ve dönüşüme maruz kalan unsurların başında ulus-devletler gelmektedir. Bu süreçte devletler arasında karşılıklı bağımlılığın artması ile ulus-devletlerin sınırları farklı güç, amaç, kimlik ve ağlara sahip ulus-ötesi aktörler tarafından sürekli olarak geçilmektedir. Sınırların adeta ortadan kalkması ile ulus-devletler ekonomik krizler, insan güvenlik, terörizm, çevre ve iklim sorunları gibi uluslararası güvenlik sorunlarından daha fazla etkilenir hale gelmişlerdir. Bu çalışmanın amacı küreselleşme sürecinde ulus-devletlerin egemenliklerinin erozyona uğramasının nedenlerini analiz etmek yanında ortaya çıkan yeni güvenlik sorunları karşısında ulus-devletlerin yalnız başlarına çözüm üretmede yetersiz kalmaları sebebiyle işbirliğinin önemine vurgu yapmaktır.
Türkiye’de Kamu Yatırımlarının 1999-2017 Yıllarındaki Dağılımı: Doğu ve Güneydoğu Anadolu İllerinin Göreli Konumu
Authors: TURAN İdris
Published: June 2020

Türkiye’nin Doğu Anadolu Bölgesi ve Güneydoğu Anadolu Bölgesi’nde bulunan 23 ile yapılan kamu yatırımlarının, diğer bölgelerdeki illere yapılan yatırımların çok gerisinde olduğu iddiası toplumda yaygın olarak bulunmaktadır. Bu iddia genellikle malum terör örgütü sempatizanları ve elemanları tarafından halkı etkilemek ve propaganda amacıyla kullanılmaktadır. Hâlbuki gerçekte durum ne şekildedir? Hükümetler Doğu Anadolu ve Güneydoğu Anadolu’yu ekonomik olarak ihmal etmişler midir? Bunu anlamanın yolu kamu yatırımlarının illere göre dağılımını analiz etmekten geçmektedir. Bu çalışmada 1999-2017 yılları arası son 19 yıldaki kamu yatırımlarının Doğu Anadolu ve Güneydoğu Anadolu illeri ile diğer illerin karşılaştırması yapılmıştır. Çıkan sonuçta görülmüştür ki Doğu ve Güneydoğu illeri ile diğer illere yapılan kamu yatırımlarının dağılımı oransal olarak benzerlik gösterdiği tespit edilmiştir.