bluuebunny/crossref_metadata_2025 huggingface dataset:
Scrub typhus in children: Clinical profile and complications at a Tertiary Care Teaching Hospital in Uttarakhand
Authors: Kumar Shruti , Kumar Mritunjay , Aggarwal Bindu , Kumari Rashmi
Published: June 2020

Background: Scrub typhus is an acute febrile illness caused by rickettsia Orientia tsutsugamushi. Rickettsial infections are grossly underdiagnosed in India because of their non-specific clinical presentation, low index of suspicion among clinicians, and lack of diagnostic facilities. Objective: Objective of the study is to study the clinical profile, complications, and outcome of pediatric scrub typhus. Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India, over a period of 2 years from November 2013 to October 2015. Children up to 18 years of age with signs and symptoms compatible with scrub typhus along with serological confirmation were included in the study. Serological study was conducted using rapid immunochromatographic assay and/or immunoglobulin M enzyme-linked immunosorbent assay technique. Clinical presentation, laboratory findings, complications, and outcome of these children were recorded on a performa. The data were analyzed using SPSS version 20 for windows. Results: About 115 children were diagnosed as scrub typhus during the study period. All children presented with fever. Other common symptoms were myalgia (56%), vomiting (50.5%), abdominal pain (26%), headache (28%), facial puffiness (15%), and seizures (8.7%). Pallor was present in 48% of children. Other common signs were hepatomegaly (29%), splenomegaly (28%), hypotension (24%), edema (21%), oliguria (17%), maculopapular rash (10%), meningeal signs (10.4%), and conjunctivitis (3%). Thrombocytopenia (67%), anemia (51%), pleural effusion (23%), shock (16%), hepatitis (23%), acute kidney injury (17%), meningoencephalitis (10%), myocarditis (7%), and acute respiratory distress syndrome (7%) were the complications observed. Azithromycin, doxycycline or chloramphenicol were used for the treatment. Overall mortality rate was 12.2%. Conclusion: A high degree of suspicion and knowledge of geographicaldistribution of rickettsial diseases is crucial for its early diagnosis and favorable outcome. The presence of an eschar is a valuable clinical clue in the diagnosis of scrub typhus; however, its absence does not rule out the disease.
Silvery gray hair syndromes: An insight into diagnosis
Authors: Hemalata L , Pradeep R , Siddavatam Supriya , Benakappa Asha
Published: June 2020

Context: Silvery gray hair syndromes consist of three conditions, Chediak–Higashi syndrome (CHS), Griscelli syndrome (GS), and Elejalde syndrome (ES), which are rare autosomal recessive diseases presenting in childhood. They have similar skin and hair changes but differ with respect to the other clinical findings. Aim: This retrospective study was taken up to identify the spectrum of silvery gray hair syndromes diagnosed over a period of 10 years (2006-2015) in a super specialty pediatric institute and also to identify characteristic clinical and diagnostic findings. Methods: A total of 17 children diagnosed to have silvery gray hair syndrome over a period of 10 years (2006-2015) at Indira Gandhi Institute of Child Health Hospital, Bengaluru and were studied retrospectively. Complete blood counts, peripheral smear study, and microscopic examination findings of the hair were analyzed. Radiological findings were also considered. Results: The most common syndrome in the study was GS Type II (10 cases) followed by CHS (5 cases), with one case each of GS Type III and ES. Conclusion: This study emphasizes the importance of silvery gray hair as a clue to diagnose these rare genetic disorders with proper clinical examination and simple diagnostic procedures.
Study of serum vitamin B12 levels in pregnant mothers and their newborns and its relation to growth of the infants
Authors: Jali Sujatha , Gajjar Rinkal , Kamate Mahesh
Published: June 2020

Introduction: The effect of vitamin B12 deficiency in pregnancy on the growth of infants has not been properly studied. Objectives: To study the correlation of vitamin B12 levels in pregnant mothers with vitamin B12 levels in their newborn infants and to know it’s relation to the growth of infants. Materials and Methods: Hundred full-term pregnant women and their newborns were enrolled from January 2011 to January 2012. Vitamin B12 levels were assessed and the growth of infants monitored till 6 months of age. Results: A total of 60 pregnant women (60%) had vitamin B12 deficiency while 29 newborns (29%) had low vitamin B12 levels. Vitamin B12 levels in the newborns had a strong positive correlation with mothers’ vitamin B12 levels (r=0.56; p<0.05). Babies born to vitamin B12 deficient mothers were shorter, and their mean weight at 6-month of age was significantly less. Conclusion: Vitamin B12 deficiency is very common in Indian pregnant mothers; it leads to vitamin B12 deficiency and growth retardation in their babies.
Randomized controlled trial: Role of glycerin suppository for promoting feeding tolerance in preterm very low birth weight neonates
Authors: Sharma Abhinav , Bansal Rajesh , Bhambri Alka , Chaudhary Sanjata Roy
Published: June 2020

Background: Feeding intolerance is a common problem in preterm infants delaying establishment of full enteral feeding (FEF). Sustained parenteral nutrition has many disadvantages. To promote feeding tolerance, glycerin suppository is being used. Aims: (a) To compare the efficacy of glycerin suppository versus no intervention in preterm, very low birth weight (VLBW) neonates in achieving FEFs, i.e., 180 ml/kg/day for at least 24 hrs both the groups. (b) Correlation of glycerin suppository with time to regain birth weight, necrotizing enterocolitis, and adverse effects following glycerin suppository. Materials and Methods: The present study is a prospective randomized control trial; study population - 50 VLBW (birth weight between 1000 and 1500 g) or preterm (gestational age between 28 and 32 weeks) neonates randomized to either glycerin suppository group or non-intervention group. Intervention group – glycerin suppository (1 g) once daily from day 2 to day 14 of life or non-intervention along with intermittent oral feeds and standardized care. Results: A total of 58 neonates were assessed for eligibility, 50 randomized to either glycerin suppository group or control group, 19 neonates in both the groups were analyzed for outcome. Mean time to achieve FEFs was 11.57±1.21 days in glycerin suppository group and 11.84±1.25 days in control group which was not statistically significant (p=0.441; RR=0.67; 95% confidence interval=?0.539, 1.079). There was no significant difference observed in secondary outcomes. Conclusion: Prophylactic glycerin suppositories did not reduce the time to achieve FEFs in preterm VLBW neonates in our setting.
Hyperglycemia in transported neonates: A tertiary care experience
Authors: Mishra Nihar Ranjan , Sahoo S K , Panda S
Published: June 2020

Introduction: Hyperglycemia is common in low birth weight and sick neonates which affect them adversely due to hyperosmolarity. As these neonates need often referral to higher setup, maintenance of euglycemia during transport should be emphasized. Objective: To know the prevalence of hyperglycemia on admission among outborn neonates and analyze the association of different transport variables and other clinical parameters with it. Methods: An observational, analytical, and cross-sectional study was designed and conducted on outborn neonates, enrolled by simple consecutive sampling from November 2014 to October 2016. All data were analyzed using SPSS version 24 and Microsoft Excel version 16 software. Results: Out of 394 outborn neonates, 33.75% were hyperglycemic. 76.4% newborns were transported by ambulance, 94.9% were stabilized before referral, 61.2% had accompanying paramedics, 86.5% neonates given intravenous fluid (IVF) during transport, 61.4% transported by moderately equipped, and 38.6% by poorly equipped vehicle. Admission hyperglycemia was significantly associated with variables such as gestational age, birth asphyxia, type of transport vehicle, duration of transport, IVF during transport, hypoxic ischemic encephalopathy, and neonatal jaundice with p<0.05. Logistic regression model taking variable which shows a strong association, we can predict 70.3% time correctly the hyperglycemia on admission. Conclusion: Prevalence of hyperglycemia found to be quite common in referred neonates. Although there is quite improvement in neonatal transport due to the implementation of various government transport schemes for patients, specialized neonatal transport service with accompanied skill personnel and care during transport is a long way to go.
Pulse oximetry screening for critical congenital heart disease - Experience in a public hospital in India
Authors: Palve Nandkishor , Utture Alpana , Nanavati Ruchi , Hire Akshay , Kerkar Prafulla
Published: June 2020

Background: Critical congenital heart disease (CCHD) if undiagnosed in the first few days of life is associated with high morbidity or and mortality. Pulse oximeter screening for CCHDs in newborn babies can aid in early recognition with the prospect of improved outcome. Routine pulse oximetry screening of asymptomatic infants for CCHD is prevalent in developed countries but not in India. Aims: To estimate the diagnostic accuracy of screening for CCHD with a new generation pulse oximeter in a setting of a public hospital in India. Materials and Methods: A prospective observational study including all term neonates (>37 weeks) admitted to the postnatal ward. Results: 1594 term newborns were screened by pulse oximetry. Of these, 1589 (99.69%) neonates passed the screening and 5 failed the test. For CCHD, sensitivity was found to be 100% with a specificity of 99.94% and positive and negative predictive value was 80% and 100%, respectively. Peripheral perfusion index (PPI) was 2.04 in infants who passed the test in comparison to 0.65 in those who failed the test. Conclusion: Pulse oximetry has a high sensitivity, specificity, and negative predictive value for detection of CCHD in newborn infants. PPI is a good predictor of systemic hypoperfusion in CCHD.
Mortality and morbidity profile of preterm very low birth weight infants: A prospective longitudinal observational study
Authors: Bansal Anuradha , Chawla Deepak
Published: June 2020

Objective: To study the survival to discharge and immediate outcome of preterm very low birth weight (VLBW) infants. Materials and Methods: Design: Prospective observational longitudinal study. Setting: Level II neonatal intensive care unit in a tertiary care center. Subjects: All live born inborn babies with birth weight 401-1499 g or gestational age between 22 weeks 0 day and 31 weeks 9 days. Outcome: Key outcome was survival to discharge for preterm VLBW infants. Incidence of major morbidities was assessed. Results: Of 183 neonates enrolled in the study, 73.2% babies were alive at initial disposition. Respiratory distress syndrome was the most common morbidity, and infection was the most common cause of death. Lower gestational age and low APGAR score at 1 min were the most significant predictors of poor outcome. Conclusion: This study provides a baseline database for evaluating the efficiency of perinatal services in a tertiary care center. Further large-scale trials are needed to substantiate our findings and to study neurodevelopmental outcome of VLBW infants.
Outcome in twin gestations: A prospective observational study
Authors: Patil Swapnil , Utture Alpana , Mondkar Jayshree , Goel Sorabh
Published: June 2020

Background: Incidence of twinning has increased due to the widespread use of assisted reproductive techniques. Twin gestation is associated with many maternal, fetal, and neonatal complications. Objective: The objective of the study is to study the fetal and neonatal complications and outcome of twin pregnancies. Materials and Methods: This is a prospective observational study conducted in a tertiary referral neonatal intensive care unit. 50 consecutive pairs of twins were recruited at the time of admission of the mother to the labor ward. Demographic details of the mother and of the infants were recorded. The outcome of the pregnancy was noted, and the live born infants were followed during the hospital stay and then up till 6 months of corrected gestational age. Results: Incidence of prematurity was 60%. Moderate to severe discordancy was identified in 17 (34%) pairs of twins and 43% infants were born small for gestational age (SGA). Intrauterine Fetal Death was noted in 6 out of 54 infants with discordant growth and 1 out of 46 infants with concordant growth (p=0.046). The overall mortality in our study was 13.9%. Mortality in SGA infants was 23% and 6% in appropriate for gestational age infants (p=0.036). Conclusion: Twinning is associated with high incidence of prematurity, growth discordance, congenital anomalies, intrauterine fetal death, and neonatal mortality.
Knowledge, attitude, and practices of nursing mothers toward breastfeeding in a tertiary care center in Navi Mumbai
Authors: Sharif Mumtaz , Saxena Amit , Nair Shweta , Sharma Ashok , Jain Prashant
Published: June 2020

Objective: Breastfeeding (BF) has been accepted as the most vital intervention for reducing infant mortality and ensuring optimal growth and development of a child. A major barrier to successful BF is inconsistency in information and improper cultural practices. To assess the knowledge, attitude, and practices toward BF among nursing mothers following up in a tertiary care center in Navi Mumbai, Maharashtra. Methods: A community-based cross-sectional study was conducted among 512 mothers in Navi Mumbai in the state of Maharashtra, India, between January 2016 and June 2016 using a pre-set questionnaire. The mothers with children under the age of 2 years were interviewed following which descriptive statistics were obtained. Results: Our study highlights the growing awareness of the advantages of BF. Of the 512 mothers enrolled in our study, 78.9% believed in exclusive BF (EBF) till 6 months while 51% actually practiced EBF. Nearly 78% mothers felt shy to feed in public places. BF was initiated <1 h of delivery in 35.9% mothers while insufficient milk was the predominant reason (41.4%) in mothers to stop BF before 2 years. Conclusion: The majority of our participants had adequate knowledge and a positive attitude toward EBF, with right posture practiced while feeding.
Assessment of knowledge regarding breastfeeding mothers in the immediate postpartum period
Authors: Mangalgi Sharanabasavesh , Sudheendra Manasa
Published: June 2020

Objectives: To assess the knowledge of mothers regarding breastfeeding in the immediate postpartum period.Materials and Methods: The study was conducted in a tertiary care teaching hospital. The postnatal mothers included in the study were interviewed with a predetermined questionnaire regarding the knowledge of breastfeeding and its importance. Results: A total of 97 mothers were interviewed, of which 69 were delivered normally and 28 by cesarean section. 51 mothers were primigravida and 46 mothers were multigravida. 80 mothers were in the age group of 20-30 years and 34 mothers came from joint family. Around 62.9% mothers had an overall good knowledge score. 100% of the mothers in the study knew the correct position of breastfeeding, 99% of mothers knew breast milk is better than commercial baby food and bottle feeding and had to breastfeed during the night. 96.9% knew they had to inform the doctor about lactation status before obtaining prescriptions for drugs or consumption of drugs. 50.5% had knowledge regarding expressed milk. 35.1% knew about the benefits of breastfeeding to themselves, contraceptive effect of was known in 21.6% mothers. Conclusions: Health-care professionals should ensure proper initiation of breastfeeding following childbirth in all institutionalized deliveries. Irrespective of the parity status, counseling must be provided to all mothers regarding feeding. Knowledge regarding expressed breast milk its technique and storage needs to be impressed on as this becomes a crucial factor in working women.
Oral health knowledge and oral hygiene practices of pre-school teachers in a selected region of Kathmandu city
Authors: Dikshit Parajeeta , Limbu Senchhema , Gupta Sujaya
Published: June 2020

Background: Dental caries and periodontal diseases are the most common oral health problems seen globally. Schools provides an ideal environment for all forms of education, including oral health and teachers can be instrumental in imparting it. The teachers, therefore, need to be well versed in the knowledge regarding oral health as well as practice good oral hygiene measures to teach the children. Objectives: The objective of this study is to assess pre-school teachers’ oral health knowledge and oral hygiene practices in a selected region of Kathmandu city. Methodology: An observational, descriptive cross-sectional study was conducted on preschoolteachers in a selected region of Kathmandu city. The teachers of pre-school level completed a self-administered structured questionnaire on knowledge of oral health and oral hygiene practices Result: The pre-school teachers had more knowledge about dental caries than about periodontal diseases. Overall, scores of school teacher’s (n=95) oral health knowledge were inadequate (54.7%) but the oral hygiene practices (69.5%) were found to be good. Conclusion: The pre-school teachers had inadequate oral health knowledge but good oral hygiene practices. This shows a need for training and motivation of pre-school teachers’ regardingthe oral health education and promotion through school-based programs.
Effect of black tea consumption on onset of action of benzodiazepines in children: A case–control study
Authors: Mishra Nihar Ranjan , Panda Prakash Chandra
Published: June 2020

Introduction: Benzodiazepines (lorazepam and diazepam) are the drugs that have calming effects, but caffeine of black tea is a stimulant. Hence, taking black tea along with benzodiazepines might block the calming effects of the latter. In our locality, giving black tea to the children is a regular sociocultural practice by their parents. Objective: To know the effect of black tea consumption on onset of action of benzodiazepines in children. Methods: An observational analytic matched case–control study was done in our department from January 2015 to June 2015 subjected to interview schedule by simple consecutive sampling, and data were analyzed using SPSS version 24 software after proper consent and ethical committee approval. Inclusion criteria of cases were any child taking black tea routinely between 1 and 15 years of age attending our outpatient department or inpatient department requiring intravenous (IV) benzodiazepines medications, and exclusion criteria were critically ill children, having chronic liver or kidney diseases, and children taking anticonvulsants regularly. Children of identical age groups, not taking black tea at all, requiring IV benzodiazepines were taken as controls. Results: An independent t-test showed a significant difference in the onset of action of lorazepam in black tea drinkers (M=5.44 h, standard deviation [SD]=2.43h) and in non-drinkers (M=1.65 h, SD=0.74h); t (99.06)=13.94h, p=0.016 and for diazepam in drinkers (M=1.65 h, SD=0.74h) and in non-drinkers (M=0.93 h, SD=0.37h); t (98.23)=16.58h, p=0.005. Conclusion: Black tea delays the onset of actions of benzodiazepines. Hence, it is advisable not to give black tea to the children, and further studies on this aspect are warranted.
A case of fibrodysplasia ossificans progressiva with sternocleidomastoid muscle calcification
Authors: Kumar Kurrey Virendra , Rakesh Nahrel
Published: June 2020

Fibrodysplasia ossificans progressiva (FOP) is a rare and disabling genetic condition characterized by congenital skeletal malformations and progressive heterotopic ossification in humans with no ethnic, racial, gender, or geographic predilection. Diagnosis of this condition can be made clinically in the presence of radiographic evidence of heterotopic ossification along with symmetrical malformations of the great toes. The course of the disease is unpredictable and often progresses in the early childhood and patients become immobile and confined to a wheelchair by their twenties. Survival beyond the third decade is uncommon. We hereby report a case of FOP in a 7½-year-old girl.
Internet and adolescence
Authors: Roy Manas Pratim , Agrawal Amit
Published: June 2020

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Clinical profile of children with Fanconi anemia from a tertiary center in Southern India
Authors: Meera V
Published: June 2020

Objectives: The aim of this study is to observe the clinical spectrum of presentation of Fanconi anemia (FA) in children presenting to the Hematology Department of Victoria Hospital, Bangalore Medical College and Research Institute. Materials and Methods: This observational study was carried out from February 2010 to December 2016 on all the 16 consecutive children <18 years of age, with FA. Those with high frequency of chromosomal breakage in G-banded metaphases from mitomycin-treated cultures were considered as positive cases. Results: The mean age at presentation was 6.79±1.34 years, but for those with dysmorphic featureson examination, it was 4.77±0.98 years. Symptoms of anemia were seen in 14 (87.5%) and of bleeding in 8 (50%) cases. There was a history of prolonged fever at presentation in 5 (31.2%) cases. Dysmorphic features on examination were seen in 10 (62.5%) cases. Short stature and microcephaly and microphthalmia were the most common features. Pancytopenia was seen in 68.7% of the subjects at presentation and anemia in 87.5% of cases while thrombocytopenia was universal (100%). The mean hemoglobin was 5.33±0.36 g/dL, mean white blood cell count was 3429.37±477.65/mm3, and mean platelet count was 28156.25±4199.44/mm3. The bone marrow was hypoplastic in 14 (87.5%). Pelvic kidney seen in 5 (31%) was the most common ultrasound finding. Parentalconsanguinity was seen in 50% of cases. Conclusion: Parental consanguinity was common, and there was a male preponderance in our study. The most common presenting manifestations were anemia followed by bleeding. Two-third of the patients had pancytopenia at diagnosis while thrombocytopenia was universal (100%). In the presence of a family history and/or dysmorphic features, even mono- or bi-cytopenias should be evaluated for inherited bone marrow failure syndromes.
Probiotics in acute diarrhea: A randomized control trial
Authors: Kumar Dinesh , Singh Mukesh Vir , Sharma Indra Kumar , Shukla Krishna Mohan , Kumar Durgesh
Published: June 2020

Background: Probiotics have been used for long in the treatment of acute diarrhea although their efficacy has always remains the subject of discussion. Objective: To determine the effect of probiotics in acute diarrhea among the children in rural population. Method: Double-blinded randomized control trial. We included children of age group 6 months - 5 years suffering from acute diarrhea of <48 h and fulfilling the inclusion criteria. All children were given oral rehydration salts (ORS) ad-lib till the resolution of diarrhea and zinc 20 mg/day for 14 days while intervention arm (n=101) were given probiotic sachet twice a day for 7 days containing Streptococcus faecalis 30 million, Clostridium butyricum 2 million, Bacillus mesentericus 1 million, Lactobacillus sporogenes 50 million, control group were given identical placebo apart from ORS and zinc. Duration of diarrhea in both the groups was measured as primary outcome while secondary outcome was to know the days of maximum recovery from diarrhea in both groups. Results: Totally, 207 patients were randomized to control and study group, out of which, 195 completed the study. Out of total 195 patients, 94 (48.2%) patients were treatedwith standard treatment of diarrhea without probiotics while 101 (51.8%) patients were given probiotics apart from standard treatment of diarrhea. The mean duration of diarrhea was found to be reduced in the study group (4.6 days [2.84-4.776 days]) as compared to control group (5.31 days [5.108-5.512 days]), p<0.001. Conclusion: Probiotics significantly reduced the duration of acute diarrhea in children.
Effectiveness of an intensive lifestyle modification program in reducing the weight of obese children aged 12-18 years
Authors: Gopinath Reetha , Jacob Ambili Susan
Published: June 2020

Objective: To find out the effectiveness of an intensive lifestyle modification program in reducing the weight of obese children aged 12-18 years. Material and Methods: Quasi-experimental single group pre-test/post-test study was conducted for 1 year in the outpatient unit of a tertiary care hospital. Obese children aged 12-18 years who gave consent to participate in the study were included as the study subjects. Obesity was diagnosed based on revised Indian Academy of Pediatrics (IAP) 2015 reference percentiles that have been proposed for Asian Indian children with a body mass index (BMI) >27 kg/m2 adult equivalent cut-off taken as obesity. Intervention done was lifestyle modification including diet and moderate aerobic exercises under supervision thrice a week, 1 h each day. Results: A total of 72 children were initially enrolled, and final analysis was performed on 58 children. After completing the 6 months program, the mean BMI reduced from 29.31±4.83 kg/m2 to 27.27±4.46 kg/m2. The mean weight of the study participants decreased to 70.82±16.43 kg from 76.1±17.98 kg, both of which were statistically significant. Conclusion: Study shows the effectiveness of an intensive lifestyle modification program of diet and exercise in reducing the weight of obese children.
Mean platelet volume as a marker of Kawasaki disease in children
Authors: Roy Soumya , Majumdar Sumit Datta , Chakrabartty Subroto , Chakravarti Swati
Published: June 2020

Background: Kawasaki disease (KD) is a clinical diagnosis, with common confusion among other causes of febrile illnesses. There are no confirmatory laboratory parameters for diagnosing KD. Objective: To investigate whether low mean platelet volume (MPV) is associated more with fever due to KD than due to the other common causes. Methods: This retrospective case-control study was done on febrile children between 6 months and 6 years of age admitted from January 2015 to January 2017. The MPV values of 28 KD and 50 non-KD febrile children admitted to our hospital were obtained from the hospital records. The diagnosis of KD was accepted only when (1) two pediatricians had agreed upon the diagnosis independently based on the American Heart Association guidelines 2004, (2) no other cause of fever coexisted with KD in a particular patient, and (3) prompt clinical response within 48 h of administration of intravenous immunoglobulin. Using suitable statistical software, the range of MPV in KD fever and non-KD fevers was compared. Results: MPV was lower in the KD group (9.75±0.98 femtoliter) than in the non-KD fever group (11.14±1.53 femtoliter). From the receiver operating characteristic curve, it was found that at MPV ?10.0 fl, KD can be diagnosed with 75% sensitivity and 80% specificity. This means that lower the value of MPV, lower is the probability that a non-KD patientwill be wrongly diagnosed as KD. Conclusion: Our study shows that low MPV is associated with KD. Hence, a low MPV can raise the index of suspicion for KD in febrile children, especially in cases of incomplete KD. Further, prospective studies involving larger sample size are needed to ascertain its diagnostic utility.
Risk factors for relapse in childhood steroid sensitive nephrotic syndrome
Authors: Balaji J , Kumaravel K S , Punitha P , Rameshbabu B
Published: June 2020

Background: Nephrotic syndrome (NS) generally tends to follow a benign and chronic relapsing course. Relapses are a major problem in children with steroid sensitive NS (SSNS). Objective: To identify the risk factors for frequent relapse (FR) in the first episode childhood SSNS. Methods: This prospective study was conducted in the Government Dharmapuri Medical College Hospital, Tamil Nadu, between July 2013 and January 2016. Children aged 9 months - 12 years with a diagnosis of SSNS (first episode) who came for follow-up for at least 12 months in the pediatric nephrology clinic were included. The enrolled cases were divided into 2 groups: (1) frequent relapser (FR) and (2) infrequent relapser (IFR). 9 factors were studied as possible risk factorsfor relapse. The data collected were analyzed using Chi-square test and Student’s t-test. Results: Of 160 SSNS children, there were 92 (57.5%) cases of IFR and 68 (42.5%) cases of FR. There were 97 males (60.6%) and 63 females (39.4%) with a male to female ratio of 1.5:1. The mean age of presentation was 4.37±2.32 years. The mean time taken to achieve remission during the first episode was 1.94±1.04 weeks. The interval between remission and first relapse was 5.56±4.51 months. Incidence of infection and hypertension was 31.9% and 37.5%, respectively. Risk factors significantly associated with FR were: Time taken to achieveremission during the first episode (>14 days) (p<0.0001), mean duration of interval between remission and first relapse (within 6 months) (p<0.0001), associated infections (p<0.0001) and hypertension (p<0.0001). Age at onset, sex, serum albumin, 24 h urine protein, and azotemia did not influence the FR in our study. Conclusion: More than 14 days to achieve remission during the first episode, relapse within first 6 months, associated infections and hypertension were the factors associated with FRs.
Magnetic resonance imaging brain findings of pediatric HIV cases and its correlation with clinical and immunological stages of the disease: A study from a tertiary care center of Rajasthan
Authors: Sulaniya Pawan K , Sulaniya Chandrakanta , Singh Jagdish , Garg Kapil
Published: June 2020

Objective: To study the magnetic resonance imaging (MRI) brain findings in pediatric HIV patients and to correlate them with clinical and immunological staging. Methods: This study was conducted in the Department of Pediatrics of a Teaching Institute of Rajasthan. It was a prospective longitudinal study, conducted over a period of 15 months (April 2008-July 2009). Diagnosis of HIV was confirmed and classified in clinical stages and immunologic stages as per NACO guidelines. MRI brain was done in every patient. Patients with abnormal MRI brain findings were further studied and correlated with clinical findings and CD4+ cell counts. Results: We had total 109 HIV-positive patients registered with us; out of these, 90 were in regular follow-up. Out of these 90 patients, 16 subjects (17.78%) showed abnormal neuroimaging features on MRI brain. No case presented with abnormal MRI features in clinical Stage I and II. 4 were in clinical Stage III, and 12 were in Stage IV. No case presented with abnormal MRI in immunological Stage I and II. 5 cases (31.25%) were in immunological Stage III and 11 (68.75%) in Stage IV. Out of total 90 subjects, only 10 patients had abnormal clinical (neurological) manifestations and rested 80 patients were neurologically and developmentally normal. 6 out of 16 (37.5%) patients with abnormal MRI brain findings did not show any neurological manifestations. The most common MRI brain abnormality noted was cerebral atrophy in 7 (43.75%) cases followed by nonspecific demyelination in 31.25% cases, and ventriculomegaly, nonspecific calcification, and infarcts in 3 (18.75%) subjects each and cerebellar atrophy in 2 subjects. Conclusions: Our study demonstrated that abnormalities of MRI brain increases with increasing immunosuppression and advancing clinical stage. We did not found any significant correlation with age and sex with abnormal MRI brain findings. Importantly, HIV?positive children may present with only abnormal MRI brain findings without any clinical manifestation.
Nutritional rickets - A hospital-based study from Southern Kerala
Authors: Krishnan Rekha , Shanavas A , Geetha S , Joseph Susy
Published: June 2020

Objective: The aim of this study is to find the characteristics of nutritional rickets and the proportion of cases diagnosed prospectively. Methods: Details of 54 cases of nutritional rickets in the age group of 1 month-12 years diagnosed during 2013-2015 in a tertiary care teaching hospital in Kerala were collected. The criteria taken for diagnosis were clinical features, biochemical parameters such as calcium, phosphorous, alkaline phosphatase (ALP), radiological features, and response to vitamin D treatment. Vitamin D level and serum parathyroid hormone levels were collected whenever it is available. The data were then analyzed statistically. Results: Among the 54 cases analyzed, 61.11% were male. A maximum number of cases were identified in the age group of 1-2 years (44.44%). Nearly 88.89% of patients were born term. About 83.3% of patients were intermediate or dark skinned. The most common clinical feature identified was bowlegs. Radiological features were identified in 70.4% of cases. The most common biochemical abnormality noted was elevated serum ALP (83.33%). Hypocalcemic seizures were a predominant manifestation in <6 months’ age group. Rickets was detected prospectively in 26 patients (48.15%) during evaluation for other illnesses. The mean ALP level was found to be significantly lower in patients with clinical or radiological features of rickets compared to those without clinical or radiological evidence. Conclusions: Rickets is very common in the age group of 1-2 years and among exclusively breastfed term babies. The significant number of cases of nutritional rickets was detected prospectively during evaluation for other illnesses. ALP level may be routinely checked in the vulnerable high-risk age group for identification of early rickets as it is significantly elevated even before clinical and radiological changes appear.
Prevalence of hypertension and its association with obesity in children of selected schools of Bengaluru city
Authors: Devadas Sahana , Arun P , Premalatha R
Published: June 2020

Background: Childhood hypertension and its association with obesity are becoming important issues worldwide. The prevalence of hypertension and obesity are increasing in both developed and developing countries. Objectives: To determine the prevalence of hypertension among school-aged children in Bengaluru and to determine whether or not obesity is associated with hypertension. Materials and Methods: Six schools were selected at random from an area in Bengaluru. A total of 3,000 students studying from 1 to 10 grades were included in the study. The students were visited at school, and their weights, heights, and blood pressures (BP)were measured. The World Health Organization’s references were used to determine the prevalence of overweight, obesity, and hypertension. Results: The prevalence of hypertension and obesity were 3.5% (n=106) and 8.2% (n=247), respectively. Sex and obesity were found to be positively associated with hypertension. Conclusion: The prevalence of obesity and hypertension are high among school children of 6-15 years of age in Bengaluru. Obesity is positively associated with hypertension. BP measurements should be part of routine school health examination, especially in obese children.
Clinico-etiological profile of raised aminotransferases in hospitalized children with liver disease and correlation with their severity level
Authors: Udawat Priyanka , - Shambhavi , Sitaraman S
Published: June 2020

Objective: The aim of this study was to analyze the clinico-etiological profile of raised aminotransferases in children with their severity level. Materials and Methods: We retrospectively analyzed 65 admitted children aged 1 month to 18 years with raised aminotransferases levels from January 2015 to July 2015. We divided them into three groups based on more liver specific, alanine aminotransferase (ALT) levels as mild (1-3 times of normal), moderate (3-20 times of normal), and severe if ALT ?20 times. Results: Total 65 children were retrospectively studied with a mean age of 72±52 months (range 1 month - 18 years), and male: Female ratio of 1.5/1. These patients were divided into three groups on the basis of their maximum ALT levels. Average levels of deranged ALT (mean±standard deviation) in mild, moderate, and severe groups were 78.8±27, 289±153, and 1938±861 IU/L, respectively. Out of 65 children, the clinical presentation was acute hepatitis in 35 (53%), acute liver failure in 15 (23%), acute on chronic liver failure in 7, and chronic liver disease in 8 patients. The etiologies were acute infective hepatitis in 41% (27) followed by metabolic in 15% (10), extra hepatic obstruction (7), autoimmune hepatitis (5), ischemic causes (7), neonatal hepatitis (2), hemophagocytic lymphohistiocytosis (HLH) (2), drug induced (2), cryptogenic (2), and diabetic ketoacidosis (1). Mild elevation of aminotransferases (n=17) was most commonly seen in metabolic liver disease (35%) followed by biliary tract obstruction (28%). Moderate elevation of aminotransferases levels (n=24) was seen in acute infective (29%) followed by metabolic liver disease (16%). In patients with severe elevations (n=24), the most common etiological diagnosis was acute infective hepatitis in (70%) followed by ischemic hepatitis (20%). The most common cause of acute infective hepatitis was acute viral hepatitis A. Conclusion: On the correlation of raised ALT with etiology, we suggest that severity grading of deranged aminotransferases can guide toward etiological diagnosis and narrow down the specific investigation required. Thus, it may help in early diagnosis and cost-effective management.
Neonatal resuscitation guidelines - A survey among pediatricians attending a newborn conference in North Kerala
Authors: Pavithran Kavitha , Jacob Ambili Susan , Diwakaran Binoo
Published: June 2020

Background: Meticulous understanding and adequate skills for prompt neonatal resuscitation by health-care personnel working in the labor, maternity, and newborn units is important. Various studies have identified areas of non-uniformity among pediatricians regarding neonatal resuscitation practices. Aim: The aim is to evaluate the knowledge among pediatricians regarding the current neonatal resuscitation guidelines and the practices they follow in their unit. Materials and Methods: A cross-sectional survey of 17 questions, based on guidelines of Neonatal Resuscitation Program (NRP) 2015 and Navjaat Shishu Suraksha Karyakram, wasconducted using a questionnaire distributed to pediatricians attending a neonatology conference. The responses were noted andanalyzed using SPSS. The relation of knowledge score with demographic profile and status of training was assessed. Results: The response rate was 66%. Majority (52%) of the participants were working in private hospitals. Neonatal intensive care unit with mechanical ventilation facilities was available for 60% of respondents. Nearly 40% were trained in neonatal resuscitation. About 85% reported correct knowledge regarding effective chest compressions. Nearly 50% reported the use of room air for bag and maskventilation during resuscitation in babies more than or equal to 35 weeks. Tracheal suction was practiced by 54% in meconiumstained liquor, and 55% practiced delayed cord clamping for 30-60 s. Nearly 62% did not have oxygen blender in the resuscitation corner, whereas 33% had cardiac monitor. No significant association was found between the place of work and knowledge score (using Chi-square test for association, p=0.280). Designation of the delegate did not have a significant association with knowledge score (p=0.300). Knowledge score of delegates from teaching hospitals was not superior to those from the non-teaching hospitals.No significant association was found between knowledge score and training (p=0.999). Conclusions: Knowledge about neonatal resuscitative practices in pediatricians as well as infrastructural facilities needs to be improved with regular NRP training.
Utility of serial serum C-reactive protein in the diagnosis of neonatal infection
Authors: Sundarapandian Santhakumar , Chinnakkannan Selvakumar , Ahmed M Shafath , Das Rashmi Ranjan
Published: June 2020

Introduction: C-reactive protein (CRP) has been used as a biomarker to diagnose neonatal sepsis. Aim: The aim of the study was to study the utility of serial CRP levels in the neonatal infection/sepsis diagnosis. Materials and Methods: Neonates admitted to a tertiary care teaching hospital were classified into three groups: proven sepsis (culture positive from any body fluid), probable sepsis (culture negative but clinical and laboratory parameters suggestive of sepsis), and no sepsis (not suggestive of sepsis). CRP was measured as follows: CRP 1 at the time of clinical presentation and CRP 2 and 3 at 24 and 48 h, respectively. Sensitivity, specificity, predictive values, and likelihood ratios were calculated. Results: Suspected infection/sepsis was evaluated as earlyonset(?72 h) in 300 neonates and late-onset (LONS) (>72 h) on 150 occasions in 100 neonates. There was a strong correlation etween the diagnoses of proven or probable sepsis and elevated CRP levels (?1.0 mg/dl), for both early- and LONS episodes, supporting the diagnostic utility of CRP. The sensitivity of CRP 2 was > CRP 1, but maximum sensitivity was achieved by CRP 3 level only. A CRP level has a much higher predictive value in ruling out than ruling in neonatal infection/sepsis (reaching almost 99-100% for both sepsis types). Conclusions: Serial CRP measurements are useful in the diagnosis of neonatal infection/sepsis. The predictive value of CRP 1 level being normal at initial evaluation cannot justify discontinuing antibiotic therapy. CRP 3 level may virtually rule out or rule in the diagnosis of neonatal sepsis.
Clinicoetiology profile of neonatal seizures in tertiary care Level II neonatal intensive care unit
Authors: Bagla Jyoti , Garg Hariom , Gulati R K , Gupta P P
Published: June 2020

Objective: To study the incidence, etiology, and pattern of neonatal seizures and its relationship with age of onset, gestation, and other obstetrical factors. Design: Prospective observational descriptive study. Setting: Level II neonatal intensive care unit of a Government Medical College Hospital. Participants: 72 neonates with neonatal seizures admitted at our hospital and developed seizures before 28 days of life. Results: The incidence of neonatal seizure was 11.93/1000 live births. The seizures were more common in male babies and in term newborns (72%). Half of the babies with neonatal seizures were low birth weight (LBW), but seizures were significantly more in appropriate for gestation age in comparisons to small for gestation age babies. Seizure frequency was not different in babies born intramural or extramural and also in deliveries conducted by doctors, nurses, or TBAs. Subtle seizures were the most common pattern observed in both term and preterm newborns (38.9%) followed by generalized tonic (22.3%). Birth asphyxia was most common etiology followed by meningitis in our study. Conclusion: Birth asphyxia meningitis, hypocalcemia, and hypoglycemia are common etiology, and the majority present within the first 72 h of life. All the high-risk newborns (asphyxiated or LBW) should be monitored at least 72 h of birth for seizures.
Incidence of acute renal failure in birth asphyxia and its correlation with hypoxic-ischemic encephalopathy staging
Authors: Chetty Sanjeev , Kajjam Sandeep Kumar , Patel Abhishek
Published: June 2020

Introduction: Acute renal failure (ARF) is a recognized complication of birth asphyxia and it carries a poor prognosis. Early recognition of ARF is particularly important in asphyxiated neonates with hypoxic-ischemic encephalopathy (HIE). Objectives: To determine the incidence of ARF in term asphyxiated neonates and to correlate it with HIE staging. Methods: A total of 50 term (37-42 weeks) neonates born with Apgar score of <7 at 5 min after birth were selected as cases and 50 normal term (37-42 weeks) neonates as controls. All asphyxiated neonates with clinical features of HIE are staged by Sarnat and Sarnat staging. Gestational age, birth weight, relevant perinatal history, and examination findings are recorded in predesigned pro forma. After 72 h and before 96 h of life, blood was collected and sent for relevant investigations, and clinical condition of the neonate and urine output were monitored and neonates were managed according to the standard protocol. Results: Incidence of ARF is significantly more in cases (76.0% vs. 4.0%) than the controls. Among 38 cases with ARF, 32 (84.2%) had pre-renal ARF and 6 (15.8%) had intrinsic ARF. On the basis of urine output, 12 (24.0%) had oliguric ARF and 38 cases (76.0%) had non-oliguric ARF while out of 50 controls, 2 (4%) neonates had pre-renal and non-oliguric type of ARF. Incidence of ARF correlated well with HIE staging. Among the 50 cases, 32 (84.3%) improved clinically after fluid therapy, while 6 (15.7%) did not improve. Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. ARF in birth asphyxia is predominantly pre-renal and non-oliguric type and it responds to fluid challenge. ARF in birth asphyxia correlates well with HIE staging.
Retinopathy of prematurity in a tertiary care center: A study of prevalence, risk factors, and outcomes
Authors: Kumar K Lathiesh , Seeralar A T Arasar , Kamalarathnam C N
Published: June 2020

Background: Retinopathy of prematurity (ROP) is a serious complication of prematurity treatment and can lead to blindnessunless recognized and treated early. Objectives: The objectives were to estimate the prevalence of ROP in preterm infants in theneonatal intensive care unit (NICU), to identify the risk factors which predispose to ROP, and to assess the outcome of these cases.Methodology: A retrospective screening survey was performed enrolling all premature neonates admitted to the NICU betweenJanuary and December 2016, with a gestational age of 32 weeks or less at birth and a birth weight of 1500 g or less. Infants whosegestational age was >32 weeks or birth weight was >1500 g were included if they were exposed to oxygen therapy for more than7 days. A total of 344 neonates had a retinal evaluation by indirect ophthalmoscopy from the fourth postnatal week and followedup periodically. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Infants who progressedto Stage 3 ROP were given laser therapy. Results: Out of the studied 344 neonates, 66 (19.2%) developed ROP in one or botheyes; 36 (54.5%) cases had Stage 1, 18 (27.3%) cases Stage 2, and 12 (18.2%) cases had Stage 3 ROP. None had Stages 4 and5 ROP. The 12 cases diagnosed as ROP Stage 3 underwent LASER therapy. Univariate analysis showed a significant relationshipbetween the occurrence of ROP and gestational age (p=0.001), sepsis (p=0.004), oxygen therapy (p=0.018), and frequent bloodtransfusions (p=0.030). However, an insignificant relationship was found between the occurrence of ROP and factors such asgender, mode of delivery, birth weight, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage,hypotension, phototherapy, and duration of oxygen therapy, mechanical ventilation, and continuous positive airway pressure.Gestational age, sepsis, oxygen therapy, and frequent blood transfusions remained significant variables after logistic regressionanalysis. Conclusion: The prevalence of ROP in this study was 19.2%; low gestational age, sepsis, oxygen therapy, and frequentblood transfusions were significant risk factors for ROP. LASER was effective in the treatment and decreasing the progression ofROP.