bluuebunny/crossref_metadata_2025 huggingface dataset:
Tyrosinemia type 1: A case report
Authors: Prabhakar Shashikala , Banu Nasima , Meghana S
Published: June 2020

Tyrosinemia Type 1 is a rare inherited metabolic disorder attributable to a deficiency of enzyme fumarylacetoacetate hydrolase. It has an autosomal recessive pattern of inheritance. The accumulation of tyrosine and its toxic metabolites succinylacetone and succinyl acetoacetate in various tissues leads to the characteristic hepatic failure, renal dysfunction, and neurological crisis. Here, we present a case of a 7-month-old female infant who was brought with complaints of jaundice, dyspnea, altered level of consciousness, refusal to feed. We highlight the need for early diagnosis, including prenatal testing and initiating treatment at the earliest, which goes a long way not only in the survival, but also the quality of life in these patients.
Urinary tract infection at presentation of nephrotic syndrome: A clinical evaluation
Authors: Sreenivasa B , Murthy C L Srinivasa , Raghavendra K , Basavanthappa S P , Pejaver Rajath , Jadala Hareesh Vardhan , Rajashekar Somarouthu
Published: June 2020

Aims: The aim was to study the incidence, etiology, clinical features and the antibiotic sensitivity pattern of urinary tract infections (UTI) in children at presentation of nephrotic syndrome (NS) (first or recurrent episodes before starting immunosuppressive therapy). Methods: This was a prospective hospital-based study carried out in Basaveshwara hospital, Chitradurga. Fifty children with a diagnosis of NS were studied from June 2010 to October 2014. The cases with recurrence of NS or those with the first episode of NS were evaluated before placing on immunosuppressive therapy. A clean-catch midstream urine specimen was collected from all children to avoid contamination. For younger children, where collection of urine was difficult in the manner described above, suprapubic aspiration was done. Prompt plating of the urine specimen, within 1-h of a collection, was ensured. Identification of the organism and antibiotic sensitivity patterns was determined.Results: Among the fifty children studied, boys were affected more than the girls with a ratio of 1.5:1. The mean age was 4.75 years. Pyuria was noted in 64% of the patients. The most common organism isolated was Escherichia coli in 10 cases, followed by Klebsiella pneumoniae in 4 cases. About 75% of the organisms were sensitive to third-generation cephalosporins. Conclusions: UTI is a common infection accompanying NS. A high index of suspicion and early institution of appropriate antibiotics will help in attenuating morbidity and mortality.
Clinical profile of empyema in tertiary health care center, Hyderabad
Authors: Shah Kalindi , Shaikh Farhan , Poddutoor Preetham Kumar , Kancherla Ramesh
Published: June 2020

Objective: Empyema thoracic is known to have a variable age group affection, causative agents and controversy regarding primary mode of management. The aim of this study was to study the epidemiology, management strategies including investigations and outcome of empyema in the children. Methods: A prospective study was done on all cases of parapneumonic empyema admitted to our hospital from February 2009 to April 2011. Diagnosis of empyema was confirmed by chest X-ray, pleural fluid analysis or radio-imaging. All children (depending on staging) were treated along with parental antibiotics and chest tube drainage either intrapleural urokinase or surgery (video assisted thoracoscopy surgery [VATS] or thoracotomy) according to British Thoracic Society guidelines. Results: Among study population, male to female ratio was 1.48:1. The most common age group affected was 1-5 years (mean 4.03 ± 3.30 years). Total 31.57% of the cultures were positive. The most common isolated organisms were Streptococci (38.9%) and Staphylococci (44.4%). Out of 57 children, 25 had Stage II of empyema while 32 had Stage III of empyema. There was a significant correlation betweenduration of illness (>7 days) and advancement in the stage of empyema (p < 0.0001). Only one child with Stage II of empyema required surgery while remaining all other (24 out of 25) were managed with thoracostomy and intrapleural injection of urokinase. Remaining 32 (18 VATS and 14 thoracotomy) patients with Stage III of empyema underwent primary surgical management. There was no significant difference in the duration of fever remission, total hospital stay or duration of IV antibiotics in children treated either with intrapleural fibrinolytics or surgical management. Overall outcome of empyema was excellent, mortality was less than 1.5%, with overwhelming sepsis. Conclusion: Staging of empyema at initiation of treatment helps in proper management of patients. Results with the use of intrapleural fibrinolytics were promising in the Stage II of empyema. As complications are very few, VATS is a safe procedure in experienced hands.
Tele-ophthalmology in retinopathy of prematurity screening – A study from a referral government hospital
Authors: Bhardwaj Prarthna V , Aradhya Gayathri H , Reddy Bharat , Basavaraj A C
Published: June 2020

Objective: The aim was to assess the role of tele-ophthalmology in retinopathy of prematurity (ROP) screening and to identify the risk factors for ROP. Design: Prospective cohort study. Setting: Level 2 neonatal intensive care unit (NICU) at a Government Hospital in Davangere, Karnataka. Subjects: 381 babies born <32 completed weeks of gestation admitted in NICU during study period. Methods: Examination of the eyes was done by a trained technician using a Ret Cam digital imaging, designed by The Karnataka Internet assisted Diagnosis ofROP, Narayana Nethralaya under the National Rural Health Mission scheme. It was later interpreted by a trained ophthalmologist using the concept of teleopthalmology. Babies were followed up and screened once weekly up to 3 months of age. Results: The overall incidence of ROP in our study was 25.2%. 3.8% of babies had Stage 1 disease, 3.8% had Stage 2, 53.8% had Stage 3, and 38.4% had Stage 4 disease. 34.2% of the babies who received oxygen therapy developed ROP. Anemia and respiratory distress syndrome have shown to significantlyincrease the risk of developing ROP. Two babies with ROP underwent light amplification by stimulated emission of radiation treatment and one baby underwent supplementary treatment. Conclusion: The incidence of ROP among high risk babies is significant and teleophthalmology can play a significant role in timely screening of babies in the remotest parts of the country. Oxygen therapy, anemia and respiratory distress syndrome were found to be significant independent factors predicting the development of ROP.
A rare case of pediatric enteroplueural fistula, which presented as lung abscess
Authors: James Saji , Agarwal Prakash , Vinoth P N , Subramanian Balagopal , Rakesh P
Published: June 2020

We report a case of a 14-year-old male patient referred to us as a case of right-sided lung abscess. The patient was treated for the enteric perforation elsewhere, following which he developed productive cough, which progressively worsened. The preoperative diagnosis of entero-pleural fistula was made with the help of thoraco abdominal computed tomography scan after 4 months of antitubercular and antibiotic treatment. Enteric perforation leading to entero-pleural fistula is very rare. The patient did well after laparotomy and completeexcision of the fistula.
Cysticercal encephalitis with disseminated cutaneous cysticercosis: A case report
Authors: Verma Parul , Verma Nishant
Published: June 2020

Cysticercal encephalitis is a severe and frequently fatal neurological disorder seen in endemic regions. We report a young male who presented with refractory status epilepticus along with numerous subcutaneous swellings over the body. His neuroimaging revealed the classic “starry sky” appearance, suggesting a diagnosis of cysticercal encephalitis along with disseminated cutaneous cysticercosis. He was managed with supportive care, antiepileptics and steroids. In endemic regions, neurocysticercosis should be considered as a differential diagnosis in children presenting as acute encephalitis syndrome. A careful physical examination along with early neuroimaging will help in establishing the diagnosis promptly.
Ruptured pulmonary hydatid cyst - masquerading as tuberculous pleural effusion in a child
Authors: Mishra Rajeeva , Shankari Vidhya
Published: June 2020

We report a case of intrapleural rupture of hydatid cyst of the lung in a 12 year old female child who presented with a persistent cough since 3 years. She was misdiagnosed as tuberculous pleural effusion, which on contrast enhanced computed tomography thorax was diagnosed as ruptured hydatid cyst. She was treated conservatively and referred for further surgical correction. Following the surgical correction, the patient condition improved dramatically.
An unusual presentation of extra-hepatic portal venous obstruction
Authors: Krishna Vidya , Ramanan Padmasani Venkat , Sankaranarayan Shuba , Prabaharan Krithika
Published: June 2020

A 13-year-old girl presented with short duration of fever, left upper abdominal pain and massive tender splenomegaly. There was no evidence of liver dysfunction or significant history. Evaluation revealed multiple splenic infarcts with portal vein thrombosis. She developed splenic abscess and was managed conservatively with percutaneous drainage and antibiotics.
Neonatal small left colon syndrome - Radiological diagnosis by gastrografin contrast study
Authors: Sharma Shashi , Sharma B B , Chamaria Komal , Bansal Kush
Published: June 2020

Neonatal small left colon syndrome (NSLCS) is one of the suspected diagnoses if the neonate does not pass meconium within 24 h of birth. Radiological contrast studies play a vital role in diagnosing and treating the entity. We report a case where the newborn did not pass meconium till 4 days of birth and which on gastrografin studies was diagnosed as a case of NSLCS.
Hypoplasia of left pulmonary artery: A rare congenital heart disease
Authors: Purani Charul , Mehariya K M , Gupta Kirti , Patel Priyansi
Published: June 2020

Unilateral hypoplasia or absence of pulmonary artery is a rare pulmonary vascular anomaly that is usually associated with other cardiac anomalies like Tetralogy of Fallot or cardiac septal defects, but can also occur as an isolated anomaly. We present a case of 6-monthold infant who presented with recurrent respiratory tract infection. On work up, chest X-ray showed ipsilateral small hemithorax with hyperluscency in the left lung field. Findings were confirmed with 2D echocardiography and pulmonary angiography which were suggestive of hypoplasia of left pulmonary artery.
An unusual case of pancytopenia in an adolescent girl
Authors: Mishra N R , Panda P C , Das S , Arun M
Published: June 2020

Patients with disseminated tuberculosis (TB) have varied presentations like pyrexia of unknown origin, hepatosplenomegaly, lymphadenopathy and meningitis, but pancytopenia is rare. Sometimes the cause of pancytopenia is not discernible after initial investigations. Such cases need further evaluation to know the etiology of pancytopenia for appropriate management of the patient. The present case was misdiagnosed as nutritional anaemia, which after thorough workup was diagnosed as disseminated TB. We are reporting this case in view of extreme rarity of TB presenting with pancytopenia.
Atypical presentation of Niemann-Pick disease
Authors: Keshavamurthy Mysore Lakshmikantha , Basavaraja G V , Rajeshekarmurthy G R , Sanjay K S , Premalatha R
Published: June 2020

Niemann-Pick (NP) disease is a distinct disorder with specific clinical and morphological manifestations. We report a 2-year-old girl who presented with normal development, acute onset of pallor, lethargy, and massive splenomegaly, which made us to think of hemolytic anemia as the initial diagnosis. Her bone marrow done, after initial hematological work up being normal, showed NP cells. As the child did not have any neurological abnormality, she was diagnosed as NP Type B (NPD-B) storage disease. We report it as a typical presentation of NPD-B.
Evaluating the quality of life in asthmatic children less than 5 years in an urban setting in Mumbai: A pilot study
Authors: Pherwani Asha
Published: June 2020

Introduction: Quality of life questionnaires (QOLQs) are an important part of the clinical assessment. There are few studies in India evaluating QOL in children with childhood asthma. Objectives: The objective was to construct a parent answered QOLQ for asthmatic children under 5 years of age and to compare QOLQ with symptoms. Materials and Methods: Exploratory/pilot study conducted between January and December 2011 in asthma clinic of an urban teaching hospital. Asthmatic children below 5 years of age, who had at least three asthma attacks in the past year, were included in the study. A QOLQ was constructed having 18 items,distributed under four domains (symptoms, environment, physical activity, and behavior). Validity of QOLQ was checked and was presented to parents in a simple language, and they were taught to score them from 1 to 7. Results: Study consists of 41 asthmatic children (mean age = 3.7±1.1 years) with 26 (63.8%) male and 15 (36.5%) females. 15 age-matched (mean age 4±1.2 years) normal controls were also taken. The mean score was significantly higher (p?0.05) for the domain of symptoms (4.2±2), than the domains of environment (3.6±1.8), and behavior (3.6±1.6), and these were higher than those of physical activity (3.2±2.65, p?0.05). The meandomains of asthmatics were significantly higher (30-34%) than the controls, suggesting that the QOLQ was measuring what it was supposed to measure. Scores of the QOLQ correlated with the severity of symptoms. Conclusion: It is possible to determine the QOL of children below 5 years of age with parents acting as a proxy. However, larger data is needed to confirm its clinical usefulness and application.
Clinical profile of dengue infection in a tertiary care hospital
Authors: Eregowda Adarsh , Valliappan Subramanian
Published: June 2020

Background: Dengue is a major international health concern that is prevalent in tropical and sub-tropical countries. The total burden of febrile illnesses that presents to primary health facilities due to dengue in different parts of Karnataka is largely unknown. Objective: The objective was to study the different clinical manifestations, trend, and outcome of dengue cases admitted in a tertiary care hospital. Materialsand Methods: Prospective study conducted over a period of 6 months (July-December 2013) in a tertiary care hospital at Bangalore. Dengue serology was done for all suspected subjects by enzyme-linked immunosorbent assay method. Detailed clinical and demographic details were taken at admission and serial close monitoring for signs and symptoms was done to watch for the progression of the disease. Results: Of the 100 children admitted with probable dengue fever, 57 had confirmed dengue illness. Of these 57 cases, most of the cases were male, and 34 (60%)cases were in age group of 5 months to 15 years with mean age of 7.5±4.7 years. Among the serology confirmed cases, the most common presentation was fever in 57 (100%), followed by abdominal pain in 37 (65%), rashes in 31 (54%), myalgia in 26 (46%), and vomiting in 23 (40%) cases. The most common hemorrhagic manifestation was cutaneous bleeding manifestations like petechiae. Of 57 cases, 46 patients had dengue with no warning signs, 8 had dengue fever with warning signs, and 3 had severe dengue. Conclusion: Clinical manifestations of dengue seem to be changing. Fever, rash, and body ache are still the common manifestations; however, clinicians in the endemic areas should be aware of unusual and novel presentations such as fulminant hepatic failure, splenomegaly, and myocarditis also.
Association of feeding practices and immunization with nutritional status of infants in jasra block of Allahabad district
Authors: Mishra Mili , Singh Richa , Dwivedi S , Hassan M A , Parveen K , Khan M A
Published: June 2020

Objective: The objective was to find the association of feeding practices and immunization with nutritional status of infants in Jasra Block of Allahabad district. Materials and Methods: A cohort study was conducted in a rural community among infants born during the period of November 2011 to April 2012. Information, Education and Counselling was given to their mothers starting from last 3 months of pregnancy and continued till the newborns completed 1-year of age. Then feeding practices, immunization, and nutritional status (in terms of weight for age) was assessed. Results: About 56.25% infants were exclusively breastfed and 53.75% infants were timely started on complementary feeding. 87.5% infants were fully immunized and the rest 12.5% were partially immunized. Growth of more than half of the infants, i.e., 47 (60%) followed a normal growth curve and weight of 33 (40%) infants was below 2 standard deviation. There was no significant difference between the mean weight at birth (i.e., 2.56 kg for infants with adequate feeding and immunization practices and 2.51 kg for infants with inadequate immunization and feeding practices). On the other hand, difference in the mean weight among two groups at 3, 6, and 9 months was statistically significant. Conclusion: Feeding practices and immunization have an association with nutritional status of infants in terms of better weight for age.
A study to assess the knowledge and attitude of parents of children with epilepsy
Authors: Manju V M , Joshi Poonam , Gulati Shefali
Published: June 2020

Objective: The objective was to evaluate the knowledge and attitude of parents of children with epilepsy toward the disease. Methods: In this cross-sectional, descriptive study, parents of 60 children with epilepsy from pediatric neurology clinic of All India Institute of Medical Sciences were enrolled. Data on epilepsy were collected using pre-tested and validated self-developed knowledge, belief, and attitude questionnaire (?=0.85, 0.89). Results: The mean knowledge and attitude scores of parents of the children with epilepsy were9.82±3.9 (2-22) and 31.25±9.27 (0-40), respectively. Parents of the children with epilepsy had poor 50 (83.3%, scores <60%) to fair knowledge scores (60-70%). Majority of the parents 33 (55%) had excellent attitude (?80%), while 11 (18.3%), 6 (10%), and 10 (16.7%) parents had good, fair, and poor attitude, respectively. Correlation between knowledge and attitude was found to be very weak and negative (r=?0. 039, p=0.77) with few misconception related to disease and clear idea about the activities to be performed with/without caution. Conclusion: There is a need for developing informational booklet and conducting educational sessions on epilepsy for the parents in particular and public in general.
Knowledge, awareness, and practice of postnatal care among mothers
Authors: Purani Charul , Patel Purvi , Gupta Kirti , Mehariya K M , Holda Ahesanali
Published: June 2020

Objective: The objective was to study the knowledge, awareness, and practices regarding the postnatal care among the mothers. Design and Setting: A pre-structured and pre-tested questionnaire was used to evaluate knowledge and awareness of postnatal care in mothers at a tertiary care center. The questionnaire was given after stabilization between 1 and 5 days of the postnatal period. Materials and Methods: Totally, 200 postnatal mothers (18-35 years) out of 540 mothers who were given antenatal and postnatal education in our antenatal care center were selected. Study Period: June 2013-September 2013. Results: Knowledge of mothersregarding breastfeeding practices (78%), thermal care (89%), skin and eye care (72%) was good. They have poor knowledge regarding dangers of pre-lacteal feeds (45%), timing of first bath after birth (60%), umbilical cord care (60%), and vaccination (36%). About 32% of them are practicing oil instillation into nostrils while 44% of mothers were intended to use gripe water for infantile colic. Conclusion: The study highlights that there is vital need to improve the knowledge and awareness in the society regarding communitybased newborn care. We should also strive toward helping removing myths and wrong practices, which are rampant in the community.
Isolated congenital absent aortic valve cusps in a fetus: A case report
Authors: Sivanandam S , Mackey-Bojack S M
Published: June 2020

Congenital absence of aortic valve cusps is an extremely rare congenital heart malformation. The absence of aortic valve cusps leads to severe aortic regurgitation with resultant rapid and progressive heart failure and growth retardation in the fetus. Congenital absence of the aortic leaflets in association with other cardiac defects has been reported in the literature, but the isolated anomaly is not reported yet. We present a case of a fetus with isolated congenital severe aortic regurgitation from absent aortic cusps and pathological specimen of this rare entity.
Association between Takayasu’s arteritis and active tuberculosis in a child: A case report
Authors: Koreti Sunita , Verma Y S , Patel G S
Published: June 2020

Takayasu’s arteritis (TA) is an autoimmune disease that affects large arteries. A possible relationship between TA and tuberculosis (TB) has been suggested as both diseases have similar chronic inflammatory lesions and occasionally granulomas in the arterial walls. TA commonly presents with cardiac involvement and rarely with sole presentation of ischemic stroke. Response with anti-tubercular drugs and steroid has been well-documented. Only a few studies have been published on TA with TB in children. We present a case of a 9-yearold  boy who was presented with low-grade fever, persistent headache, vomiting, and abnormal body movements and on further workup was diagnosed as a case of active TB with TA.
Organophosphorus compound poisoning in newborn
Authors: Kumar Poornima , Sanketh R , Krishnan Lalitha
Published: June 2020

Poisoning is a diagnosis seldom made in neonatal intensive care units as most clinical features such as lethargy, respiratory distress,and poor feeding mimic common neonatal conditions. An 8-day-old male baby presented with complaints of inconsolable crying, poorfeeding, and seizures for 1 day. On admission, he had bradycardia, copious secretions and pin-point pupils, which led to suspicion ofcholinergic over-activity. Cholinesterase levels were 2209 IU/L in baby which increased to 5936 IU/L on day 18 of life. There wasa history of charred vasambu (Acorus calamus) being applied over the tongue. Contamination of vasambu with organophosphateswas suspected which was confirmed by high performance thin layer chromatography analysis showing chlorpyrifos derivatives. Babyimproved gradually with supportive treatment and was discharged on day 18 of life.
Rasmussen encephalitis: A case report
Authors: Gupta Rimzim , Bhargava Rashi , Gupta Rajesh Kumar , Gupta Prem Prakash
Published: June 2020

Rasmussen’s encephalitis (RE) is a chronic focal encephalitis involving single cerebral hemisphere characterized by progressive neurological dysfunction and intractable seizures. The cause is mostly unknown but proposed to be associated with immune-mediated and associated with viral infections. We report a case of RE following exanthematous illness clinically diagnosed as chickenpox.
Impact of training on community health worker regarding newborn care
Authors: Nahrel Rakesh , Kosam Ajay , Thakur Hemlata , Pandey Sachin
Published: June 2020

Background: In India, an estimated four million deaths occur each year in the neonatal period. Effective intervention at primary care level can prevent a large proportion of these deaths. Objective: To assess the impact of training on knowledge and skill regarding newborn care among Auxiliary Nurse Midwife (ANM). Methods: A total of 180 ANMs who attended skilled birth attendant training program under RCH were included in the study. The study was conducted over a period of 2 years from May 2013 to June 2015. A 14 training sessions each lasting for 15 days were conducted in 2 years and each session had a batch of 12-15 ANMs. They were assessed for the impact of training at the end of training on semi-structured and pretested schedule. Results: The knowledge of health workers related to the care of a newborn at birth was not adequate. An average of 94.8 ANMs responded correctly to pre-test questions whereas after training there was a significant improvement in the post-test score. After training an average of 160.5 ANMs (p=0.001) responded correctly. A mean of 84 ANMs had adequate knowledge related to danger signs in the neonatal period before training. Aftertraining significant number of ANMs (mean=156, p=0.002) responded correctly. Baseline knowledge related to feeding of the newborn was also inadequate (mean=120), but after training there was a significant improvement, 164 ANMs respond correctly (p=0.02). Conclusion: Knowledge of ANMs in the rural area regarding essential newborn care is inadequate. The training of health workers need to be remodeled and updated to improve neonatal outcome.
Maternal and fetal factors affecting birth length of healthy newborn babies: An observational study
Authors: Dwivedi Deepak , Verma Amit
Published: June 2020

Background: Length is an important neonatal measurement at birth. Many studies in the past have analyzed the birth weight and factors affecting it but studies that investigated the relationship between maternal factors and birth length are scarce and inconsistent. Purpose: This study was conducted with the aim to estimate the effect of maternal and fetal factors on birth length in singleton pregnancy. Methods: The present cross-sectional observational study was conducted in a tertiary care center in central India during February 2012. Of 450 deliveries, 191 newborns were included on the basis of inclusion criteria. The weight of the baby was takenby electronic weighing scale, and length was taken with infantometer. Babies were divided into two groups based on Fenton’s chart, and Group A had babies with birth length <3rd centile and Group B had babies with birth length >3rd centile. The effects of factors such as maternal age, weight during last trimester of pregnancy, education, maternal and paternal height, parity, socioeconomic status, occupation, and residence were assessed. Fetal factors such as birth weight, sex, and birth order were assessed. Results: On analysis of data, it was found that maternal weight (p<0.001), maternal height (p<0.001), and occupation (p=0.04) was significantly associated with the length of the babies. The incidence of low birth length was lesser (53.37%) among housewives as compared to working mothers (72.09%) with p<0.05. Socioeconomic status, paternal height, and parity had no significant relationship with birth length. On analysis of fetal factors, birth weight (p<0.001) and head circumference (<0.001) were significantly associated with birth length. Conclusions: It may be concluded that length at birth may be influenced by factors such as maternal weight and occupation, which indirectly show the nutritional status of the mother.
Study of acute phase reactants in children with sepsis, with special reference to C-reactive protein and procalcitonin
Authors: Murthy G R Rajashekara , Pradeep R , Sanjay K S , Kumar Vinay , Sreenivas S K
Published: June 2020

Background: Several inflammatory markers have failed to meet the requirements for an early diagnosis of sepsis in children. Study results and trends show that measurement of the combination of biochemical markers offers the best prospects for research on early diagnosis of sepsis. Objectives: To evaluate the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) as markers of early sepsis in pediatric patients. Methods: All the hospitalized children aged more than 28 days with clinically suspected sepsis, as per the definition given by International Pediatric Sepsis Consensus Conference, were selected. The patients were divided into two groups; one with culture proven sepsis and the other with culture negative sepsis. CRP and PCT levels were measured at the time of admission and 48 h after admission. Results: A 40 patients were studied, out of that 15 had culture positive and 25 had culture negative sepsis. The mean PCT level was significantly higher at admission than at 48 h after admission, and the mean CRP level was significantly lower at admission than at 48 h after admission indicating PCT as early marker of sepsis. Conclusion: CRP and PCT levels have favorable test performance in differentiating between culture positive and culture negative sepsis. PCT is earlier to rise compared to CRP and PCT is best in predicting the severity followed by CRP.
Congenital epulis: A rare benign baby lump
Authors: Xavier Rose , Ajitha M , Manoj V C
Published: June 2020

Congenital epulis is a rare congenital tumor affecting the oral mucosa. It is usually seen in females and has no known syndromic association. It may cause the interference to feeding or airway obstruction, thus presenting as an emergency. Visually, it causes a lot of undue stress and anxiety to the parents and relatives. Multiple epulis occurs only in 10% of cases. Recurrence of the tumor, malignant change, or damage to dentition is not seen post-excision. Clinicians, particularly those working in the tertiary health care facilities, should be aware of this benign and easily treatable tumor of the neonate.
Aseptic nonunion of pediatric subtrochanteric fracture: A case report
Authors: Dharmshaktu Ganesh Singh , Roy Anshuman Vijay
Published: June 2020

Nonunion of pediatric fractures related to the extracapsular proximal femur is a rare event if managed appropriately. Varus malposition renders increased stress over the fracture site leading to failure of the sound union. Management of such fractures is difficult owing to limited implant choices and presence of adjacent open physes. Open reduction and freshening of edges, removal of fibrous tissue, internal fixation with intra, or extramedullary implants, and a compliant follow-up are keys to the good functional outcome.
Temporal lobe involvement: A diagnostic challenge in Japanese encephalitis
Authors: Rajashekarmurthy G R , Keshavamurthy M L , Panigrahic Nikitha Kumari , Basavaraja G V , Srinivas S K
Published: June 2020

Japanese encephalitis (JE) and herpes encephalitis are the most common endemic and sporadic encephalitis, respectively. A 10-yearold boy, presented with features suggestive of viral meningoencephalitis, had neuroimaging suggestive of herpes encephalitis, but cerebrospinal fluid serology was positive of JE. Temporal lobe involvement in JE may cause problems in differentiating it from herpes encephalitis, which highlights the importance of both neuroimaging and serology for a complete diagnosis.
Prevalence and risk factors of diarrhea morbidity among under-five children in India: A systematic review and meta-analysis
Authors: Ganguly Enakshi , Sharma Pawan K , Bunker Clareann H
Published: June 2020

Background: Acute diarrhea accounts for a huge burden of infectious diseases in under-five children. Objective: This systematic review was carried out to study the prevalence and associated risk factors of diarrhea among Indian children aged <5 years. Methods: Papers were identified by a comprehensive electronic search of relevant medical subject heading (MeSH) terms in PubMed. Identified articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 15 articles were abstracted and reviewed to identify the reported prevalence and risk factors for childhood diarrhea. Meta-analysis was done for calculating the pooled prevalence of diarrhea and point estimates of risk factors using random effects model with use of appropriate population weights, and depicted using forest plot. Results: The overall prevalence of diarrhea between 2002 and 2013 was 21.70% (95% confidence interval [CI]: 11.24-34.46). The significantly associated risk factors were malnutrition (odds ratio [OR]: 1.73, 95% CI: 1.53-1.96) and anemia (OR: 1.71, 95% CI: 1.29-2.28) in child, and low socioeconomic status (OR: 7.14, 95% CI: 2.19- 23.32). Age of the child <24 months, not breastfeeding, mothers’ low literacy status and untreated drinking water did not show a significant association. Sex of the child, religion, higher education of mothers, and seasonality were found to be inconsistentlyassociated in single studies. Conclusion: It was concluded that there is sufficient evidence on the association of childhood diarrhea with socio-demographic factors, but evidence on other contributory factors including breastfeeding and vaccination is inconclusive. There is need to conduct more analytical studies on lesser known risk factors of diarrhea to establish their risk factors in Indian children.
A study of acute flaccid paralysis cases reported from a tertiary care hospital in Delhi
Authors: Kumar Ajay
Published: June 2020

Background: As many countries including India become polio-free, Guillain–Barre syndrome (GBS) becomes the most common cause of the acute flaccid paralysis (AFP). Objective: To describe the socio-epidemiology and causes of AFP cases reported from a tertiary care hospital in Delhi. Materials and Methods: This was a cross-sectional descriptive study based on record review of the case investigation forms of AFP cases reported from January 2011 to December 2013. Results: Total 187 cases of AFP were reported during the study period. Majority (54.01%) of the cases were male. The mean age was 5 years 3 months (range - 1 month to 13 years8 months). The age group most commonly affected was 5-12 years (43.32%) followed by 2-5 years (32.62%). Most (88.24%) of the cases belonged to low socio-economic status, with 79.68% of the cases from an urban area. Investigations were done within 48 h of the date of notification by medical personnel in 94.65% of cases. Two stool specimens were collected within 7 days of onset of weakness in 94.12% of cases and stool condition was good in all collected specimens. None of the stool samples tested positive for wild poliovirusesand vaccine derived poliovirus. Non-polio enterovirus was isolated in 15 cases (8.02%) while results were not mentioned in 12 cases (6.42%). In six cases, vaccine virus was isolated. The most common cause of AFP was GBS (32.08%) followed by isolated facial palsy (8.56%) and viral myalgia (6.95%). Conclusion: GBS was most common cause of AFP followed by isolated facial palsy. The slum area and migratory population need more attention as the majority of AFP cases were from low socio-economic status family.
Clinical profile and outcome of poisoning in children admitted to a tertiary referral center in South India
Authors: Vasanthan Mullai , James Saji , Shuba S , Abhinayaa J , Sivaprakasam Elayaraja
Published: June 2020

Background: Childhood poisoning covers the entire gamut from accidental ingestion in toddlers and preschool children to intentional overdosage in adolescents. The poisons range from fuel to drugs and other chemicals. Objective: To determine the epidemiology, clinical profile, and outcome of children presenting with acute poisoning in a tertiary care center in south India. Materials and Methods: All patients from the age of 1 month to 18 years, admitted during the 1-year study period with a history of poisoning, were included. Animalbites, snake, and scorpion envenomation were excluded. The data were analyzed using SPSS software, version 16. A multivariate analysis was also done and a p<0.05 was considerer significant. Results: There were 75 cases of poisoning out of the total 4074 admissions. Accidental poisoning constituted 73.3% cases and the remaining 26.7% were suicidal. In most of the cases, poisoning was due to fuel (28%) or drugs (21.3%), and kerosene oil was the most common causative substance (28.0%) followed by camphor (14.7%). The higher incidence of poisoning was found in lower middle socio-economic class (56.0%). An analysis of the outcome showed that92.0% were discharged home, 4.0% with sequelae, and death in 4.0% cases. Conclusion: The highest incidence of poisoning was observed in the lower middle socio-economic group. Most of the poisons were household products, and the most common nature of exposure was accidental. In most of the cases, recovery was complete.
Comparison of World Health Organization body mass index for age Z scores and revised Indian Academy of Pediatrics growth standards for the diagnosis of thinness, overweight, and obesity among adolescent girls
Authors: Venkatesh Soma , Pachaiappan Natarajan , Ramalingam Vanitha
Published: June 2020

Background: In spite of the rapid economic growth of India in recent years, the health of our children is being challenged by the troublesome duo of over nutrition and undernutrition. Determination of the magnitude of this problem needs uniform and representative growth standards across the country. Aim: To compare the prevalence of thinness, overweight, and obesity among girls aged 10-15 years belonging to urban Pondicherry using the World Health Organization (WHO) body mass index (BMI) for age Z scores and revised Indian Academy of Pediatrics (IAP) growth standards. Materials and Methods: A total of 287 girls were included in the study. Weight and height were measured for all of them as per standard guidelines and BMI were calculated. Thin, overweight and obese girls were identified based on the WHO Z scores for BMI-for-age as well as revised IAP growth standards 2015. Results: The prevalence of thinness as per WHO BMI for age Z scores was 22.6%. The prevalence of overweight and obesity were 6.6% and 2.1%, respectively. In comparison, the prevalence of thinness according to revised IAP growth standards was 10% and that of overweight and obesity were 6.3% and 1.4% respectively. The prevalence of thinness as per recent IAP growth standards is significantly less compared to the prevalence obtained using WHO Z scores. Conclusion: Using the WHO BMI for age Z scores is likely to overestimate the prevalence of thinness significantly when compared to revised IAP growth standards for Indian children. BMI for age Z scores for Indian children is needed to address this issue in large prospective multicenter studies.
Sizes of induration and nutritional status in children with positive Mantoux test
Authors: Singh Mukesh Vir , Kumar Durgesh , Kumar Dinesh , Lata Kusum , Shukla K M , Varshney Sangeeta
Published: June 2020

Background: The immune status of children is always affected by nutrition. Sometime severe malnutrition is associated with false negative Mantoux test. There is a need to study to observe the effect of nutritional status on the size of indurations in Mantoux positive children. Study Design: Observational analytical cross-sectional study. Methods: The study population consisted of 310 patients, belonging to both sexes and age of 1-14 years, attending the outpatient department of UP Rural Institute of Medical Sciences and Research, Saifai, Etawah. Only Mantoux positive cases were included in the study. Their sizes of indurations of skin reaction weremeasured and recorded in mm. The nutritional status was calculated as the weight for age and height for age standard (Z-score), using the NCHS charts of for males and females. Results: Out of 800 children screened for tuberculosis, 310 children had positive Mantoux test and were recruited in the study. Mean induration (20 mm) was similar in all the groups. However, the size of indurations ranged from 10-40 mm, 11-33 mm, and 12-24 among normal weight, underweight, and overweight Z-score groups. Mean induration was same (20 mm) in two Z-score height for age groups (normal height, stunting), while it was 20.6 mm in the over-height group. Although, the range of Mantoux positivity ranges from 10-35 mm, 11-40 mm, and 18-22 mm among normal height, stunting, and over height Z-score groups. Conclusion: Although, nutritional status can affect the positivity of Mantoux test; in Mantoux positive children, the size of indurations does not depend on their nutritional status.
Bicycle handlebar injuries in children: Is “ring sign,” an indicator of intra?abdominal organ injuries?
Authors: Deepak J , Aravind K L , Shankar Gowri , Narendrababu M
Published: June 2020

Background: Children are vulnerable to a wide range of bicycle-related traumatic injuries. Bicycle handlebar injuries often cause diagnostic dilemma and delay in diagnosis due to trivial nature of the incident. Objectives: To study the bicycle handlebar injuries in children and their management. Materials and Methods: A retrospective review of all the children with blunt abdominal injuries secondary to bicycle handlebar injuries at our institution, between April 2011 and March 2015 was done. The patient medical records were examined, and all the data pertaining to the demographic information, clinical history, hematological investigations, imagingstudies, operative technique, post-operative recovery and complications, and duration of hospitalization were obtained. Results: During the study period of 48-month, 26 children with blunt abdominal injuries were treated at our institution. Among these patients, 7 children had bicycle handlebar abdominal injuries. All 7 patients were male. Mean age of the patients was 9.6 years (range 5-12 years). The average time gap between trauma and presentation to our institution was 46 h (range 22-96 h). All the 7 children had circular patternedabrasion of the bicycle handlebar over the abdominal wall. Mean duration of hospital stay was 16.1 (range: 9-28) days, and the average duration of follow-up was 35.6 months (range 7-55 months). Conclusion: “Ring sign” indicates a higher probability of associated intraabdominal injury, and these children should be thoroughly evaluated and managed with close observation, repeated clinical examination, appropriate imaging studies, and surgical or endoscopic intervention as required.
A study of abuse including physical, substance, and sexual abuse among urban adolescent children
Authors: Sanjeeva G N , Patil Alkarani T , Kumar Pragalatha
Published: June 2020

Background: Adolescents are the future citizens of a country, and it is imperative to systematically address their needs. The prevalence of abuse including physical and sexual, by these adolescents as well as against them, have been increased. Objective: The study was undertaken to estimate the prevalence of abuse including physical, substance, and sexual abuse in adolescents of Bengaluru urban. Materials and Methods: This was a cross-sectional survey conducted among the adolescents aged 10-19 years in Bengaluru. A pretestedself-designed semi-structured questionnaire which included demographic profile and details of the substance abuse (physical and sexual abuse), juvenile delinquency was used. Data were analyzed using SPSS software. Results: A total of 303 adolescents were enrolled during the study period, out of which 167 adolescents were from school and 136 adolescents from the slum. Most children (54.1%) belonged to the age group of 14-16 years. Smoking (48.5%) was the most common form of abuse among the parents. The most commonsubstance abuse seen among children was smoking (30%). Majority were involved in violence with other adolescents (71%). Sexual abuse was seen more in slum children as compared to school children. Substance abuse among children was mostly influenced by friends in 70 (40.7%) cases. Conclusion: Substance abuse was common in male slum adolescents for which peer pressure and curiosity were the main influences. More than one-quarter of slum adolescents reported physical abuse while sexual abuse was more commonly reported in female slum adolescents.
Awareness among mothers regarding oral rehydration salt solution in management of diarrhea: A cross-sectional study
Authors: Thammanna P S , Sandeep M , Sridhar P V
Published: June 2020

Background: Diarrhea remains one of the leading global causes of death among children under the age of 5 years; diarrhea and the resultant mortality from it is both preventable and treatable. Proper knowledge regarding the use of oral rehydration salt solution (ORS) helps in preventing morbidity and mortality from diarrhea. Objective: To assess the awareness, knowledge and practice of mothers of under-five children regarding the use of ORS and other alternative solution during diarrheal illness. Methods: A cross-sectionalstudy involving 250 mothers with children of age 6 months - 5 years was carried out. Data were collected using a semi-structured questionnaire; it included data regarding socio-demographic characteristics and questions pertaining to knowledge of mothers about ORS. Results: Out of 250 study participants, 203 (81.2%) mothers were homemakers and 212 (84.8%) were literate. It was seen that 63 (25.2%) mothers did not know about ORS, 146 (58.4%) knew about the role of ORS in diarrhea, 129 (51.6%) had knowledge regarding homemade ORS. Only 119 (47.6%) mothers knew how to prepare ORS properly, and the most common source of informationregarding ORS was a doctor. 84 (33.6%) mothers had a misconception about ORS, and only 51 (20.4%) participants knew about syrup zinc. The higher education level of mother was associated with better knowledge regarding various aspects of oral rehydration therapy. Conclusion: The knowledge regarding the use of ORS in diarrhea is insufficient; hence, there is need to educate mothers regarding the use of ORS as well as homemade ORS substitutes during diarrhea.
Bacterial profiles and risk factors for neonatal sepsis in a rural tertiary care hospital in north India
Authors: Sareen Aarti , Aggarwal Prerna , Mahajan Kusum
Published: June 2020

Objectives: To study, the bacterial profile in cases of neonatal sepsis admitted to the neonatal nursery or neonatal intensive care unit (NICU) and to identify the risk factors for early-onset neonatal sepsis. Design: Retrospective survey of hospital records from January 2012 to December 2012. Setting: A neonatal unit of a rural medical college hospital. Subjects: All inborn and outborn neonates who either had clinical signs of sepsis or were born to mothers with risk factors for sepsis and underwent a sepsis screen. Neonatal sepsis was defined as positive blood culture in babies younger than 1 month of age who had clinical signs of sepsis or had maternal risk factors for sepsis. Results: 396 neonates were screened for sepsis during the study period, of which 64 (16%) were culture positive. Of these, 42 (65.6%) had early-onset sepsis while 22 (34.3%) had late-onset sepsis (LOS). There were 6 deaths among those who had sepsis (9.3%). The predominant organisms in both early and LOS were Klebsiella and Staphylococcus aureus followed by Escherichia coli. Conclusion: The pattern of isolates is more or less similar to that seen in other NICU across the country. Klebsiella and S. aureus weretwo of the commonest organisms isolated in our study.
Burden of acute infections (except respiratory and diarrheal) and its risk factors among under-five children in India: A systematic review and meta-analysis
Authors: Ganguly Enakshi , Sharma Pawan K , Bunker Clareann H
Published: June 2020

Context: Acute infections of eyes, ears, skin, and others are a common cause of morbidity in under-five children. The overall burden of other infections and their risk factors is not known. Evidence Acquisition: Available literature was searched comprehensively using PubMed for acute infections (except acute respiratory and diarrheal diseases) using the relevant medical subject heading terms. Extracted articles were independently reviewed against inclusion/exclusion criteria and rated for quality. 10 articles were abstracted and reviewed to identify the reported prevalence and risk factors for acute infections among children. Results: The pooled prevalence of infections (not including acute respiratory and diarrhea) between 2002 and 2013 was 18.42 (95% confidence interval: 9.30-30.62), with reported range of 3.7-50.8%. The significantly positively associated factors reported in single studies were young age of the child, malnutrition, poor breastfeeding, low socio-economic status, animal rearing near household and mothers’ illiteracy for independent morbidities. Conclusion: The evidence on risk factors including breastfeeding, vaccination, age, and sex that predispose under-fiveIndian children to different infections is inconclusive. There is a need to conduct more studies on acute infections other than acute respiratory and diarrhea, to establish their determinants in Indian children.