bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal seizures: our experience of incidence, etiology and outcome in a tertiary care centre
Authors: Anand Veena , Pillai Swapna K , Jayakrishnan Deepa , Nair PMC
Published: June 2020

Context: Neonatal seizures often evoke a sense of urgency among physician in charge of newborn as they often indicate a CNS dysfunction. Incidence of neonatal seizures remains high in our community even in this era of advanced perinatal care. Early detection of seizure and its etiology help us to provide specific therapy.Objectives: The purpose of this study was to determine the incidence, etiology and outcome of neonatalseizures. Settings and design: Prospective hospital based descriptive study conducted in the neonatal unit oftertiary care hospital. Material and methods: Consecutive newborns admitted with seizures were included inthis study. Data were collected regarding relevant history and examination, thoroughly evaluated for etiologyand outcome was documented. Analysed by descriptive statistics and conclusions were drawn. Results: Onehundred and eight newborns with seizures were included during study period and incidence of neonatal seizure was 5.5%. Hypoxic ischemic encephalopathy (HIE) and sepsis constituted the most common etiologies. HIE was the most common etiology associated with mortality. Abnormal EEG with supressed background activity was present in majority of mortality cases. Conclusion: Most of the cases had multifactorial etiology. Measures for prevention, prompt recognition and specific management of neonatal seizure help to reduce the burden of neonatal morbidity in the community.
Knowledge, attitude, and perception of adolescents regarding reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome in Rajasthan
Authors: Bagla Jyoti , Mayanger Amrita , Bagla Rekha , Gupta P P , Gupta A P
Published: June 2020

Background: The studies are required to better understand the needs of adolescents and to help policy makers to develop appropriate need-based adolescent reproductive health programs. Objectives: The objective was to assess the awareness among adolescents regarding various reproductive health issues and to assess their attitude and perceptions regarding reproductive health and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Design: Community-based cross-sectional descriptive study. Participants: 423 adolescents of 11-19 years age group in two rural (219 students) and two urban (204 students) schools. Methodology: The survey used was a 4-part, 52-item self-administered questionnaire eliciting information on knowledge regarding reproductive health and HIV/AIDS. Result: Awareness of all reproductive health matters was suboptimum. Awareness was more in urban adolescents than in rural and in late teens than earlier teens. Overall, majority were aware of legal age of marriage (79%), two child family norm (90%), and birth spacing, disadvantages of early marriage, disfavor female feticide, and felt need for sex education (91%). Condoms were the most commonly known method of contraception among boys (80.15%) and oral pills among girls (60.24%). AIDS was the most well-known sexually transmitted disease (93.38%). Conclusion: Lacunae in awareness of all reproductive health matters suggests that young people’s sexual and reproductive health issues need to be further addressed and explored in order to promote safer and responsible sexual behavior.
Leukocyte adhesion defect: A rare cause of immunodeficiency
Authors: Chowdhary Sona , Kumar Mohitesh
Published: June 2020

Leukocyte adhesion deficiency 1 (LAD-1) is a rare autosomal recessive disorder of leukocyte function due to integrin deficiency. It is characterized by recurrent bacterial and fungal infections and depressed inflammatory responses despite striking blood neutrophilia. Severe LAD usually presents early in infancy. Here, we report a case who presented late with symptoms of LAD-1 when compared with earlier reported cases and without the usually associated infections.
Prevalence of obesity in affluent school children of Greater Noida, Uttar Pradesh
Authors: Mahato Mathura Prasad , Chandra Subhas , Bhattacharjee Prasun
Published: June 2020

Background: Childhood obesity is a state of over nutrition with long term complications such as hypertension, coronary artery disease and Type-2 diabetes. It also adversely affects psychological development causing poor body image and low self-esteem. Objective: The aim of this study was to know the prevalence of obesity in affluent school children of Greater Noida, Uttar Pradesh. Methods: This study was carried out in affluent school children of four private schools in Greater Noida, Uttar Pradesh. Height and weight of each child weremeasured, and body mass index was determined according to Quetelet’s index. Results: Totally 816 school children of 6-11 years were examined with 528 boys and 288 girls. The overall prevalence of obesity was 7.4% without significant difference in boys (7.3%) and girls (7.6%). Prevalence of obesity was high at the age of 11 years both in boys (12.2%) and girls (11.5%). Conclusion: The present study revealed that obesity has a high prevalence reaching to epidemic proportions in the affluent school children of Greater Noida, Uttar Pradesh.
Clinico-psychiatric profiles of children with self-harm poisoning
Authors: Modi Narayan Prasad , Das Dillip Kumar , Shukla Suprabha
Published: June 2020

Background: Self-harm among young people is increasing day by day and little is known about the reasons young people give for cessation and their link with gender or employment status. Objectives: The aim was to study the psychiatric aspects of self-harm and to look for underlying contributing factors responsible for self-harm. Materials and Methods: Hospital based prospective study conducted in a tertiary hospital in the eastern India. Children between 5 and 15 years of age admitted with poisoning were recruited. Extensive questionnaire was put to the admitted children and their parents. Psychiatric diagnosis and evaluation were made based on Diagnostic and Statistical Manual of Mental Disorders IV criteria. Results: Of 62 children admitted with poisoning, 20 children had self-harm poisoning. Girls outnumbered boys with ratio of 1.8:1. Though the number is less, boys had more severe poisoning requiring longer hospital stay. More than 85% children with self-harm were more than 11 years of age. Incidence was more in low socioeconomic group, and family stress was the most important contributing factor. Out of two children with recurrent self-harm behavior, one had bipolardisorder and other was having major depression. Conclusions: Self-harm poisoning is one of the significant problems in children and adolescent. In the case of recurrent episode, one should evaluate for any underlying psychiatric illness and treat the underlying illness.
Aggressive vertebral hemangioma in early adolescent age group: Atypical presentation with computed tomography and magnetic resonance imaging appearance
Authors: Sharma B B , Sharma Shashi , Sharma Sandeep , Balesa Jitendra , Jilowa Sarita , Singh Yashvant
Published: June 2020

Vertebral hemangiomas (VH) are vertebral vascular malformations, which may remain asymptomatic until adulthood. Sometimes, young individuals present with unexplained backache, which poses the diagnostic dilemma. We present a case of 15-year-old female who presented with prolonged unexplained intermittent upper back pain in the dorsal region. She was diagnosed as a case of aggressive VH after ruling out other infective and malignant pathologies and treated with decompressive therapy. The present case highlights the role of imaging studies such as computed tomography and magnetic resonance imaging in such conditions.
Improving child survival under National Health Mission in India: Where do we stand?
Authors: Khurmi Manpreet , Gupta Medhavi , Patle Ajay , Kaur Prabhjot , Mathur Nimisha , Chaudhari Gaurav , Prabhakar P K , Mohammed Suresh K , Khera Ajay
Published: June 2020

India contributes to around one-fifth of the global under-five mortality and also maternal mortality besides one-third of the neonatal mortality. Since any reduction in child mortality in India is crucial for the global decline, therefore, the Indian Government decided to undertake massive correction of the health system. This led to the launch of National Rural Health Mission in the year 2005. Since then, significant progress has been made and child mortality rates have shown a sharp decline. On comparing the progress made by the world toward Millennium Development Goals, India fares better by showing a decline of 46.5% in comparison to 41% for the entire world during the same period. In order to assess the state-wise reduction, data from sample registration system of the Registrar General of India which is available for most of the States/Union Territories (UTs) have been analyzed. States such as Maharashtra, Tamil Nadu, and Kerala have shown an impressive decline but some states such as Himachal Pradesh, Punjab, Mizoram, and Delhi still have a long way to go to reach the state specific goals and targets. Any further decline would only be possible by addressing inter-district variations that are still lagging behind and focused efforts need to be made, in order to reach these desired goals. This analysis would be valuable in planning future program implementation plans.
A randomized controlled study of nebulized 3% saline versus 0.9% saline with adrenaline in the treatment of acute bronchiolitis
Authors: Sreenivasa B , Kumar P Sunil , Babu M T Suresh , Ragavendra K
Published: June 2020

Objective: The objective was to determine whether nebulized hypertonic (3%) saline with adrenaline is more effective than nebulized 0.9% saline with adrenaline in the treatment of acute bronchiolitis. Materials and Methods: In this randomized, double-blind, controlled study 100 patients were randomly allocated into two groups (50 patients in each group). In Group A (normal saline group), 4 ml of normal saline (0.9%) and 1 ml of 1:1,000 adrenaline was given as nebulization with oxygen flow of 6-8 L/min. In Group B (hypertonicsaline group), 4 ml of hypertonic saline (3%) and 1 ml of 1:1,000 adrenaline was given as nebulization with oxygen flow of 6-8 L/min. The nebulization was given at an interval of 4 h, 6 times daily till the patient was ready for discharge. Results: The percentage improvement in clinical severity scores after inhalation therapy was not significant in Group A on 1st-3rd day after admission (3.4%, 2.1%, and 4%, respectively). In Group B, significant improvement was observed on these days (7.4%, 8.7%, and 9.9%, respectively, p<0.001). Furthermore, the improvement in clinical severity scores differed significantly on each of these days between the two groups.Using 3% saline decreased the hospitalization stay by 25%, from 3.4±1.7 days in Group A to 2.5±1.4 days in Group B (p<0.05). Conclusion: In the treatment of acute bronchiolitis, 3% saline nebulization with adrenaline decreases the length of hospitalization and symptoms as compared to 0.9% saline nebulization.
High prevalence of vitamin A deficiency among children in Meghalaya and the underlying social factors
Authors: Nongrum Melari Shisha , Kharkongor Glenn Christo
Published: June 2020

Objective: The objective was to estimate the prevalence of clinical vitamin A deficiency (VAD) in children 0-15 years, to determine the knowledge of nutrition and dietary practices, and to assess the social factors that are associated with vitamin A status in these children. Design: A cross-sectional study using household interviews with mothers of children 0-15 years and clinical examination of children for clinical VAD was conducted. A case-control study design was adopted to ascertain the knowledge and consumption of vitamin A rich foods and the associated social factors. Setting: Rural communities of Khasi tribal people in Pynursla Block, East KhasiHills, Meghalaya. Results: The prevalence of clinical VAD in children 0-15 years was 4.5% (95% confidence interval [CI] 3.32-5.98). The prevalence in school age (5-15 years) children was 5.9% (95% CI 4.12-7.68), higher than among pre-school children of 2.49% (95% CI 1.16-3.84). The community has a term for night blindness, Matiar, for which treatment is the intake of beef liver either in raw, boiled or roasted form. The control group had better knowledge of vitamin A rich food than the cases and they consumed 28% more vitamin A rich food than the cases while intake of wild edibles was higher in case group by 9%. Maternal education and familysize were found to be significantly associated with vitamin A status of children. Conclusion: VAD is a public health problem among children 0-15 years in Pynrusla Block of East Khasi Hills District, Meghalaya. In order to effectively address this problem, it is essential to enhance the knowledge of nutrition and appropriate diets and to encourage the consumption of traditional foods especially locally available vitamin A rich foods.
Newborn friendly thermometry – Comparative study of body temperature with an infrared versus digital thermometer
Authors: Bindu A , Kutty P M , Menon Ashitha , Divya P , Jose Soumya
Published: June 2020

Background: Accurate measurement of body temperature is of great importance in day to day neonatology practice. One touch infrared thermometry is safe, accurate, and easy to use. Objective: We aimed at comparing infrared forehead thermometer with an axillary digital thermometer to assess the accuracy. Methods: Axillary and forehead temperatures were measured simultaneously in normal newborn babies using digital and infrared thermometers respectively at a tertiary level teaching hospital in northern Kerala, India and the meantemperature measured by these two methods were compared. Those babies with fever or admitted at Neonatal Intensive Care Unit were not included in the study. Results: Totally, 193 newborns were included in the study with the mean birth weight of 2600±400 g. There was no significant difference in temperature measured by digital and infrared thermometers (97.74±0.91°F vs. 97.81±0.89°F, p=0.44). There was a significant positive correlation between axillary and forehead temperature (r=0.94) and mean difference between two readingswas 0.07±0.25°F (p=0.11). Conclusion: Infrared forehead thermometry is as reliable and accurate as axillary digital thermometry. Thus, infrared forehead thermometry can be used in clinical practice, especially in neonatal and postnatal wards where ease of use and speed of obtaining the temperature readings are important.
Effect of timing of cord clamping on iron stores of infants born to anemic mothers
Authors: Murtaza Kamal , Aggarwal K C , Kumar Ajay , Jindal Meera , Batra Aruna
Published: June 2020

Objective: To study the effect of timing of cord clamping on the iron stores of infants born to anemic (hemoglobin [Hb] 7-10 g/dl) mothers, and if late clamping leads to polycythemia. Design: Randomized comparative trial. Setting: Tertiary care hospital in a metropolitan city. Participants: Term, healthy, and vaginally delivered neonates without any congenital malformations or birth asphyxia, born to booked anemic (Hb 7-10 g/dl) mothers having no medical or pregnancy-related complications were included in the study.Interventions: The pregnant mothers were randomized into three groups, and their umbilical cords were clamped at 1, 2, and 3 min. Neonatal hematocrit was estimated by the capillary method at 24 h of life, and infant’s (Hb) and ferritin were obtained at 3 months of life. Main Outcome Measures: Hematocrit at 24 h of life and serum iron and ferritin levels at 3 months of age. Results: The outcome variables significantly associated (p<0.05) with hematocrit were cord clamping time, maternal Hb and cord Hb, and ferritin. That associated with infant’s Hb were cord clamping time and cord Hb and ferritin. Whereas, only cord clamp time was significantlyassociated with infant’s ferritin. None of the neonates had polycythemia, and Hb and ferritin were found to be the highest in those whose cord was clamped at 3 min. Conclusion: In resource-constrained countries, where iron deficiency anemia is a major public health problem, delaying the umbilical cord clamping by up to 3 min will reduce the incidence of infantile anemia. It will serve as an additional cost-effective intervention in anemia control program without any adverse effect of polycythemia.
Neonatal septicemia: Its etiological agents and clinical associates
Authors: Verma Pramila , Sadawarte Kalpana
Published: June 2020

Aim: To identify the common bacterial pathogens associated with neonatal sepsis and to study their systemic, focal, and hematological associates. Design: Retrospective hospital-based observational study. Setting: Level II neonatal intensive care unit. Subjects: Totally, 87 neonates with culture proven sepsis. Materials and Methods: Case records of admitted neonates (from January 2013 to December 2013) with culture-positive sepsis were reviewed. Data were collected in a predesigned proforma and analyzed for type of bacterial isolate, and clinical and hematological manifestations of sepsis. Results: Blood culture was positive in 36.8% (87/236)of the neonates with sepsis. Among the culture-positive cases, 58.62% (51/87) were male, and 51.72% (45/87) were preterm babies. Staphylococcus aureus was the most commonly isolated organism (51, 58.62% cases), followed by Klebsiella in 14 (16.09%), coagulase-negative Staphylococcus in 6 (6.89%), Acinetobacter species in 4 (4.59%), Escherichia coli in 4 (4.59%), Citrobacter freundii in 2 (2.29%), Pseudomonas aeruginosa in 2 (2.29%), and Candida species in 2 (2.29%) babies. Conclusions: S. aureus was the predominant pathogenic organism in both inborn and outborn babies while Klebsiella was the main culprit for causing sepsis in outborn babies.
Comparison of health care seeking behavior in rural versus urban women in Uttarakhand
Authors: Gera Akriti , Ramachandran Smita , Gera Rani , Singh A P
Published: June 2020

Background: Epidemiologists and social scientists have devoted increasing attention to studying care seeking behavior associated with two leading causes of death namely acute respiratory infections and diarrhea. Objective: This study was planned to assess and compare the health care seeking behavior of urban and rural population in two districts, one with better and other with poor health parameters. Materials and Methods: A cross-sectional study was planned in the state of Uttarakhand to assess the differences in care seeking behavior in its urban and rural population. Data were collected from two districts namely Dehradun and Uttarkashi. Mothers (140) having children up to 5 years of age were interviewed in both the districts and questionnaire was administered to evaluate the care seeking behavior among mothers. Results: Children <1 year and more than 3 years were reported to fall ill more than children between 1 and 3 years in both Dehradun and Uttarakashi, with fever, cough, cold, diarrhea and vomiting, and pneumonia as the most common reported diseases. The average number of symptoms care seeking pattern and hospital treatment was higher in Dehradun despite a similar level of education of mothers in both the regions. Conclusion: Dehradun, having better health facilities, could address the concerns in health of children.
Clinical profile of dengue patients: A hospital based study
Authors: Chaudhary Vinod , Khamkar Anil , Tiwari Manish , Suryawanshi Amol
Published: June 2020

Context: For most of the patients, dengue is a self-limiting viral fever, but in some patients, it results in a life threatening condition called as dengue hemorrhagic fever or dengue shock syndrome. Objective: We attempted to determine the common and atypical clinical and laboratory features in children suffering from dengue fever, which will help in early diagnosis and management of patients suffering from dengue infection. Design: Hospital based descriptive, cross-sectional study conducted from January 2014 to December2014. Setting: Tertiary referral teaching hospital. Patients: All patients between 1-month and 12 years admitted in pediatric ward with symptoms suggestive of dengue and who turn out to be positive for NS1 antigen alone or NS1 and immunoglobulin M antibody against dengue were included in the study. Data regarding relevant history and clinical examination and outcome and relevant investigations were collected. Results: Of 250 children included in the study, 145 (58%) were male and 105 (42%) were female. The most commonpresenting complaint was fever (92.8%), followed by abdominal pain (46.4%). The most common clinical sign was pyrexia followed by relative bradycardia (37.6%) and hypotension (26.4%). On laboratory investigation, the most common abnormality detected was leucopenia (81.6%) followed by thrombocytopenia (69.2%). Conclusion: A high index of suspicion is required on the part of treating pediatrician to diagnose dengue early and treat accordingly to prevent mortality due to dengue.
Oxytocin and neonatal hyperbilirubinemia: A prospective cohort study
Authors: Abbas Shakib Shafi , James Jemila , Sreedevi N , Nair P M C
Published: June 2020

Objective: To study the incidence of neonatal jaundice requiring phototherapy in babies exposed to maternal oxytocin for induction of labor and to compare the increase in neonatal jaundice in oxytocin group with the jaundice in babies born of spontaneous labor. Materials and Methods: This prospective cohort study was conducted in the neonatal unit of a tertiary care center in Trivandrum, Kerala over a period of 6 months. After exclusion, 308 babies were divided in two groups, Group A (babies exposed to maternal oxytocin for induction of labor) or Group B (babies born of spontaneous labor with oxytocin use for augmentation of labor). Babies were observed daily for clinical jaundice till discharge. Results: Incidence of neonatal jaundice in Group A was 52% and in Group B was 12% with relative risk 4.3 (95% confidence interval: 2.69-6.73). Conclusion: Our study shows that maternal oxytocin used for induction of labor increase the incidence of neonatal jaundice, and it is logical to prevent hyperbilirubinemia by reducing the dose of oxytocin.
Infantile systemic hyalinosis: A case report
Authors: Shivappa Sanjay Kantharajapura , Murthy G R Rajashekar , Murthy D V Venkatesh , Srinivas S K
Published: June 2020

Infantile systemic hyalinosis (ISH) is a rare, progressive, autosomal recessive disorder characterized by connective tissue involvement as hyaline deposition in the skin, gastrointestinal tract, muscles, glands, and other organs. We report a child with this rare condition presenting with growth retardation, joint contractures, and intractable diarrhea. Though genetically analyzed, ISH still remains as a poorly understood disease raising concerns during diagnosis and treatment.
Religious restrictions and cultural taboos related to menstruation in adolescent girls: A school-based cross-sectional observational study
Authors: Varghese Manju Mary , James Saji , Ravichandran Latha , Sivaprakasam Elayaraja , Palaniyandi Anitha , Balaji Samantha
Published: June 2020

Introduction: The period of adolescence needs special attention because of the turmoil an adolescent faces at different stages of development, different circumstances and needs, and diverse problems. In India, there are multiple restrictions and taboos related to menstruation. In many communities, the mention of the topic is taboo even today. Objective: To evaluate the religious restrictions and other taboos practiced during menstruation by adolescent school girls. Methods: A cross-sectional observational study was conductedin four schools. Girls in the age group of 13-18 years, who have attained menarche and gave verbal consent to participate, were included in the study. A pre-designed, validated questionnaire that captured information on the cultural taboos practiced during menstruation was administered to the participants. The data were analyzed using SPSS version 15 and the percentage of menstral taboos that were practiced on average was determined. Factor analysis was done to determine the most practiced taboo. Results: A total of 1522 adolescent girls participated in the study. The average age of attaining menarche was 13.08±3.5 years. 81.2% (n=1236) of the participants, predominantly from the Hindu community, did not attend religious functions during menstruation. More than half of them (56.6%) did not sleep in their usual place during menstruation. 40.1% of them (n=611) were not allowed to enter the kitchen. 69.3% (n=1054) of the participants had restrictions on certain food items. Only 5.4% (n=82) of them did not go to school during menstruation. Factor analysis showed that the two most important factors contributing to the taboos were restrictions on religious functions and on sleeping in the same place. Menstrual taboos were prevalent more in younger and less-educated girls (p=0.037 and 0.000, respectively). Conclusion: Restrictions during menstruation are still prevalent in many communities. The two most important cultural taboos are sleep restrictions and religious restrictions. Cultural taboos are prevalent more among less-educated and younger adolescent girls.
Assessment of cardiac iron overload in multiply transfused thalassemic children using T2* weighted cardiac magnetic resonance
Authors: Chate Sambhaji Chandrakant , Manglani Mamta , Pate Mona , Jankharia Bhavin
Published: June 2020

Background: Cardiac failure secondary to transfusional iron overload is the most common cause of death in patients with thalassemia. Early detection of myocardial iron deposition is necessary to prevent overt heart failure. Objective: Assessment of myocardial and hepatic iron deposition by T2* weighted magnetic resonance (MR). Materials and Methods: A total of 32 transfusion dependent thalassemic children were enrolled in a cross-sectional study conducted at thalassemia center in a teaching hospital. Gradient echo T2* MR was done in all patients for the assessment of myocardial and hepatic iron deposition. Results: Out of these 32 thalassemic patients studied, 21 (65.6%)were males and 11 (34.4%)were females. The mean age of the enrolled patients was 14.6 years (range 9-24 years). Out of 32 patients studied, cardiac iron deposition (cardiac T2* <20 ms)was present in 14 (43.8%)patients and was absent (cardiac T2* >20 ms)in the remaining 18 (56.3%)patients.The hepatic iron deposition was assessed by T2* MR in 31/32 patients. None of the patients had normal liver iron (hepatic T2* - more than 6.3 ms). Out of those 31 patients, 1 (3.2%)patients had mild (hepatic T2* - 6.3-2.7 ms), 17 (54.83%)patients had moderate (hepatic T2* - 2.7-1.4 ms), and 13 (41.93%)patients had severe (hepatic T2* - <1.4 ms)hepatic iron deposition. No significant correlation could be found between hepatic and cardiac T2* (p=0.415, Cramer’s V 0.313). The mean serum ferritin was 5202 ng/ml. No significant association wasfound between cardiac T2* and serum ferritin levels (p=0.270, Cramer’s V 0.350). Conclusion: There is no significant correlation between hepatic and cardiac iron deposition. Similarly, no correlation was seen between cardiac iron deposition and serum ferritin levels.
Determinants of survival of extremely low birth weight infants in a rural Nigerian Hospital
Authors: Babatunde O Kayode-Adedeji , Sylvester O Alikah , Irene E Akhige
Published: June 2020

Background: Over 90% of the neonatal deaths occur in low- and middle-income countries, mostly in sub-Saharan Africa, including Nigeria. Prematurity is related to more than one-third of these deaths on a global scale; with the extremely low birth weight (ELBW) category having a 100-fold mortality risk compared to the normal birth weight infants. Objective: The purpose of this study was to determine the survival rates of ELBW infants and to identify the factors associated with survival in a rural hospital in Nigeria. Materials and Methods: All the neonates admitted to the unit weighing <1000 g at admission were enrolled. The birth place,gender, gestational age (GA), birth weight, postnatal age, temperature, blood sugar at admission, and outcome were documented. None of the babies received surfactant or assisted ventilation. Results: 29 out of 992 neonates (3%) admitted to the neonatal unit over the study period were ELBW. The survival rates of the inborn and outborn neonates were 33% and 14%, respectively. Conclusions: Factors associated with increased survival were inborn, GA ?28 weeks, birth weight of 750 g, inborn and admission within 2 h of life.
Study of acute viral meningoencephalitis in children in sub-Himalayan Tarai region: Clinico-epidemiological, etiological, and imaging profile
Authors: Roy Abhishek , Mandal Kalyanbrata , Sen Sandip , Bag Toshibananda
Published: June 2020

Introduction: Sub-Himalayan Tarai region of India is an endemic area for viral meningoencephalitis where rising trend of disease prevalence has been observed over last 3 years. Objective: This study was conducted to find the viral etiology, clinical profile, and epidemiology of meningoencephalitis cases and correlate them with imaging results. Materials and Methods: A hospital-based prospective observational study was conducted over a period of 1-year (1st January-31st December 2011). Children aged 1 month to 12 years admitted with the diagnosis of viral meningoencephalitis were included in the study. Cerebrospinal fluid and serumimmunoglobulin enzyme-linked immunosorbent assay was done for herpes simplex 1 virus, measles, mumps, rubella, varicella, Japanese encephalitis, dengue, and human immunodeficiency virus, on all suspected patients. Neuroimaging (Magnetic resonance imaging brain or computed tomography head) was also performed. Results: Mean age was 5.2±3.46 years (range 1 month to 12 years) with a Male:Female ratio of 1.8:1. A maximum number of cases was recorded in monsoon. Paramyxovirus (mumps) was the most common detected virus followed by Japanese encephalitis cases. Case fatality rate for Japanese encephalitis was54.55% (95% confidence interval 39.54-69.56), and the majority of the deaths occurred in the age group of 3-7 years (38.46%). At 6 months follow-up, 71.4% were absolutely symptom free, while rest had weakness of all limbs, mental retardation, or aphasia. Conclusion: Significant encephalitis is prevalent in all districts of North Bengal. Most prevalent are JE and mumps which are vaccine preventable.
Prevalence of infections among 6-16 years old children attending a semi-rural school in Western Maharashtra, India
Authors: Mandlik R M , Chiplonkar S A , Khadilkar V V , Gupte S Phanse- , Mughal Z M , Patwardhan V G , Khadilkar A V
Published: June 2020

Background: Infections are an important cause of morbidity in rural India. Reports on the prevalence of infections in older children and their effects on growth are scarce. Objective: The objectives were to determine the prevalence of common infections among 6-16 year old school-children in a semi-rural setting in Western India and to assess the influence of infections on the growth status of the children. Materials and Methods: This cross-sectional study was conducted in a semi-rural setting in a Zilla Parishad Primary School, Karegaon, Maharashtra. 802 children (boys = 439), 6-16 years of age were assessed. Data on height, weight and infectionrelated symptoms reported by children (pre-tested, validated questionnaire) were collected. K-means cluster analysis was used to create three clusters based on the severity of infections, and one-way analysis of variance with post-hoc Tukey’s multiple comparisons was used to test the significance of differences in means of various characteristics of the subjects in three clusters. Results: 43% boys and 49% girls reported symptoms of respiratory tract infections occasionally, and 28% boys and 27% girls complained of gastrointestinal(GI) infections occasionally. Children with more severe infections were more likely to be shorter and lighter; this was more marked in girls. Conclusions: Rural school-going children (aged 6-16 years) suffer from high rates of infections, mainly upper respiratory tract infections followed by GI tract infections.
Study of sleep problems and their association with scholastic performance in school going children
Authors: Fatnani Rutva Harish , Minajagi Sunil Kumar B , Rao Chandrika , Kumar K M Satish
Published: June 2020

Background: Sleep is an integral part of any healthy individual and sleep problems can affect the intellectual abilities including the performance at school. Objectives: We studied the sleep problems among school going children in the age group of 6-16 years and the association of the sleep problems with scholastic performance in them. Materials and Methods: The study was a cross-sectional study carried out in students attending a private school. The children were given a questionnaire based on the “BEARS” screening tool for sleep problems in children to be filled by children and parents. Accordingly, the age and academic grades of students were recorded. The prevalence of sleep problems and their relation to school grades were studied. Results: Out of 229 students, 25.33% (58) students were found to have sleep problems after applying the “BEARS” criteria. Of these 58 children, 31 scored A grade, 25 scored B grade, and 2 scored C grade. 23% (31 out of 135) of A graders were found to have sleeping problems, 28% (25 out of 89) of B graders, and 40% (2 out of 5) of C graders had sleeping problems. Conclusion: Sleep problems were common in school going children. It was observedthat as scholastic grades decreased, the prevalence of sleeping problems increased. Sleep problems might be one of the contributors for poor scholastic achievements in children.
Primary empty sella and associated pituitary hormonal abnormalities in children: An observational study
Authors: Reetha G , Ravikumar P , Mahesh P
Published: June 2020

Objective: To find out the spectrum of pituitary hormonal abnormalities in children with primary empty sella syndrome. Materials and Methods: This retrospective observational hospital-based study was carried out in a tertiary care teaching hospital. Children referred to the pediatric endocrinology clinic with clinical features of pituitary hormonal abnormalities were evaluated. Children who were found to have empty sella were included in the study and hormonal profile of these children were studied. Results: There were 14 patients in thestudy group. Isolated growth hormone deficiency was the most common associated abnormality (64%) followed by multiple pituitary hormone deficiencies in 5 (35%) children. Hypothyroidism was observed in 4 patients (28%) and hypocortisolism in 2 cases (14%). Hypogonadism was observed in one girl on follow-up (7.1%). Conclusions: Significant numbers of children with pituitary hormone abnormalities have primary empty sella as a cause. Therefore, these children need to be evaluated for all pituitary hormones and shouldbe regularly followed up for evolving hormonal deficiencies.
Evaluation of current status of lead toxicity among children: A hospital based cross-sectional study
Authors: Ashoka C , Avinash T , Rani S Usha , Venkatesh T , Venkatesh T , Abraham Roy , Kulkarni M L
Published: June 2020

Introduction: Lead is a highly toxic non-essential metal. Children have a wide spectrum of subclinical and clinical effects due to lead exposure and lead poisoning. Objectives: To identify the extent of the problem of lead toxicity among children and its association with anthropometry, nutritional status and awareness about lead toxicity. Materials and Methods: Study population comprised children admitted in CSI Hospital as inpatients. Purposive sampling was done to enroll patients with no risk of lead exposure. A sample sizeof 100 was calculated using prevalence formula. Anthropometric and blood examinations were done along with knowledge, attitude and practices questionnaire to assess knowledge of caregivers about lead toxicity. Results: A total of 100 children were screened. The mean (standard deviation) blood lead level (BLL) was 7.1 (3.6). 18% of the children demonstrated BLLs of >10 ?g/dl. 19.3% of boys as compared to 15.8% girls had BLL >10 ?g/dl. 36.4% of children belonging to the lower socio-economic status had BLL >10 ?g/dl. The developmental quotient was inversely proportional to the measured BLL. Mean weight, height, and blood indices were lower in thechildren with BLL >10 ?g/dl. The knowledge regarding the adverse health effects of lead toxicity was very poor. Conclusion: Once the early toxic effects are detected before the onset of irreversible changes, the potential victims can be saved. So screening of children for lead toxicity should be made mandatory whenever doubt arises, and since knowledge regarding lead toxicity is poor among caregivers, awareness should be created through health education to the community.
Single dose oral zinc as adjuvant therapy in children admitted with severe pneumonia: A randomized, placebo-controlled study
Authors: Basavraj G V , Nijaguna N , Gembeeran Raja , Sanjeeva G N
Published: June 2020

Background: Childhood pneumonia is one of the major causes of under-five mortality in developing countries. Any interventions which can reduce the mortality and morbidity of pneumonia are of great importance. Adjuvant zinc therapy is one such intervention studied in various parts of the world with inconclusive results. Objective: We aim to study the impact of a single dose of zinc therapy on the outcome of childhood severe pneumonia. Material and Methods: Randomized, placebo-controlled study of young children between2 and 24 months was conducted to study the impact of single dose zinc administration on time to resolution of severe pneumonia. The subjects were assigned two groups, zinc group and non-zinc group, by stratified randomization. The zinc group received unlabeled oral zinc syrup 20 mg of elemental zinc as single dose for children >6 months of age and 10 mg of elemental zinc as single dose for children <6 months. The non-zinc group children were administered unlabeled non-zinc containing placebo as single dose. Results: From April2011 to December 2011, 1284 children screened for pneumonia as per Integrated Management of Neonatal and Childhood Illnesses guidelines and 126 children were included in the study. Of these 126 children, 63 were randomized to receive zinc and 63 to receive placebo. The mean duration of respiratory distress before hospitalization was 1.4±0.5 days in zinc group as compared to 1.1±0.5 days in non-zinc group (p=0.001). The mean duration of resolution of distress was 52.47±33.99 h in zinc group as compared to 74.17±37.76 h inthe non-zinc group (p=0.05). Similarly, the mean duration for resolution of symptoms was 65.52±36.03 h in zinc group as compared to 88.00±37.97 in non-zinc group (p=0.05). The 23% of the children in non-zinc group had treatment failure (p=0.03). Conclusion: Single dose of adjuvant oral zinc therapy in severe pneumonia, reduces the duration of respiratory distress, resolves the symptoms early and decreases the incidence of treatment failure. However, the total duration of hospitalization was not affected by zinc therapy.
Bacteriological profile, antibiotic sensitivity pattern, and detection of extended?spectrum ?-lactamase in the isolates of urinary tract infection from children
Authors: Shettigar Sanchita , Chandrashekar G S , Roche Ronald , Nayak Narendra , Anitha K B , Soans Santhosh
Published: June 2020

Background: Appropriate use of antibiotic in children with urinary tract infection (UTI) is essential so as to curb the spread of drug-resistant organisms. Objectives: To study the bacteriological profile and antibiotic sensitivity pattern in children with UTI and to determine the prevalence of extended-spectrum ?-lactamase (ESBL) producers of Escherichia coli and Klebsiella species. Methods: This prospective study was conducted from October 2010 to September 2011. The children between age group of 3 and 14 years who attended Pediatric Department at a tertiary care hospital were included in the study. Single midstream urine specimen was collected from each patient with suspected UTI. Result: Out of 184 urine samples with suspected UTI, 122 children had culture-proven UTI. Of 122 cases, 81 (66.39%) cases were seen in females. The most common organism isolated was E. coli (50%) followed by Klebsiella pneumoniae (23.77%) and Enterococcus species (8.19%). E. coli, Klebsiella spp., Citrobacter freundii, and Proteus mirabilis responded better to nitrofurantoin (NIT) (76.8%). Ceftriaxone (79.12%), cefotaxime (74.8%), and cefixime (71.7%) showed higher sensitivity as compared to ceftazidime (63.4%) and cefoperazone (CPZ) (59.4%). Among aminoglycosides, amikacin (82.4%) had a better response as compared to gentamicin (64.6%). Out of 61 E. coli and 31 Klebsiella species, 35 (38.04%) were ESBL producers. The sensitivity of these organisms to imipenem was 100% with a good response to meropenem, CPZ-sulbactam, and piperacillin-tazobactam. Conclusion: E. coli and Klebsiella spp. were the most common isolates and many of them were ESBL producers. NIT seemed to be a reasonable alternative to cephalosporins for the treatment of UTIs in children. Carbapenems were found to be effective in ESBLs and non-ESBL producing uropathogens and can be considered as reserve drugs.
Evaluation of role of computed tomography scan brain in children with generalized seizures
Authors: Chaudhary G S , Chaudhary V
Published: June 2020

Objective: To evaluate the role of computed tomography (CT) scan brain in children over the age of 1 year with generalized seizures. Design: Prospective, hospital-based study. Materials and Methods: Children of 1-12 years presenting with generalized seizures in pediatric outpatient department and emergencies were subjected for CT scan brain with contrast along with other appropriate investigations after stabilization. Results: A total of 101 cases of children with generalized seizures underwent CT scan brain, 36 cases (35.64%) were found to have CT brain abnormalities. Conclusion: CT brain should be considered in children with generalized seizures in health care settings where magnetic resonance imaging is either unavailable or unaffordable.
Percutaneous cannulation of central veins in neonates: Its safety and feasibility: Audit of 75 neonatal insertions
Authors: Jadhav Vinay , Shankar Gowri , Deepak J , Babu Narendra
Published: June 2020

Introduction: Central venous catheters (CVC) have become an integral part in the care of children in intensive care settings. However, their use in neonates is limited due to inherent difficulties in insertion and associated complications. Objective: We present our experience in the use of CVC by percutaneous cannulation in neonates. Materials and Methods: A total of 75 cases of neonatal percutaneous central venous cannulation inserted over a period of 6-month from March 2014 to August 2014. Data regarding age, indication for central line insertion, site of insertion, complications related to central line insertion, duration of catheter days, werecollected. Results: Of the 75 neonates, 49 were male and 26 were female. Age group ranged from 14 to 30 days with a median of 21 days. Weight ranged from 750 g to 3.5 kg with an average of 1.9 kg. The internal jugular vein was accessed in 45 (60%), followed by femoral 26 (34.6%) and subclavian in 4 (5.3%) cases. Successful percutaneous cannulation was achieved in all and the median catheter days were 12 days. The longest catheter patency was 46 days in one neonate. The most common indication for placement was failure of peripheral venous access (78%). The main complications encountered were catheter displacement (12%) and catheter malposition (9.3%). Catheter induced sepsis was seen in 7 (9.3%) neonates. Conclusion: Percutaneous cannulation of central veins in neonates is feasible, and safe, with acceptable morbidity. Ultrasound guided central line insertions is becoming the gold standard in neonates, as the entire vascular anatomy is delineated and variations in anatomy clearly identified; hence avoiding multiple attempts and complications.Contrast injected X-rays confirmation even when the catheter is radio-opaque is effective in accurate tip identification and helps in preventing tip related complications.
Oral fenofibrate in neonatal hyperbilirubinemia: A randomized controlled trial
Authors: Chaudhary G S , Chaudhary Vidya , Chaurasiya Om Shankar , Chandrakant Verma , Kumar Vipin
Published: June 2020

Objective: To evaluate the role of oral fenofibrate for lowering neonatal hyperbilirubinemia as compared to placebo. Design: Doubleblind, randomized, placebo-controlled trial. Setting: NICU of tertiary care hospital of North India. Subjects: 50 neonates with neonatal hyperbilirubinemia. Neonates (?35 weeks of gestation), birth weight (1.5-3.5 kg), jaundice beginning at day 3-11 after birth, total bilirubin level between 15 and 21 mg/dl, and clinically stable vital signs. Intervention: Neonates were assigned randomly to receive either single dose of oral fenofibrate at 10 mg/kg/dose on day 1 of admission and distilled water on the following next day or a singledose of oral glucose solution on day 1 and distilled water on the following next day. Malloy-Evelyn method was used to estimate the serum total bilirubin levels. All newborns enrolled in this study, received phototherapy. The cases were divided into two groups, i.e. study (fenofibrate) group and control group. Measurement of Primary Outcome: Duration of phototherapy. Results: Mean values for total serum bilirubin in fenofibrate group at 36 and 48 h after starting of phototherapy were significantly lower in the study group than those in the control group (p<0.00001). The mean time needed for phototherapy was also shorter in the study group than control group (p<0.0002). No side effects of fenofibrate were observed after a single dose administration. Conclusion: Fenofibrate appears to be an effective and safe drug for the treatment of neonatal  hyperbilirubinemia. This decreases the duration of phototherapy and thus shortens the length of hospital stay.
Pediatric surgical specialty in India: Sunset or in an eclipse? Current status: 2014-15
Authors: Raghunath B V , Murthy M Keshav , Girish M L
Published: June 2020

Background: Pediatric surgical specialty in India is more than 50-year-old. In spite of the advances made in pediatric surgical care, the specialty is still not being recognized as a “super specialty” and given importance in par with other super specialties. There is a decrease in the demand for pediatric surgical trainee posts. Aims: To assess the current status of pediatric surgical services in India and analyze the factors contributing to decrease in demand for pediatric surgical trainee posts. Materials and Methods: A web-based survey was conducted in January 2014. A questionnaire was sent to all members of Indian Association of Pediatric Surgeons via e-mail and the results were analyzed. Survey Monkey statistical software was used for analysis of data. Results: A total of 145 (24.5%) members responded to the survey. The majority of the members were practicing in metros and were dissatisfied because of the lesser remuneration as compared to other super specialties. However, the majority of the members were happy socially and professionally and expected a bright future for the specialty. Conclusion: Pediatric surgery, like any other surgical branch, has short comings. Pediatric surgical specialty in India is currently in an eclipse rather than in a sunset.