bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic utility of fecal calprotectin as a biomarker of gut inflammation in neonates to predict necrotizing enterocolitis: A prospective study
Authors: Shenoy Mohan T , Shenoy K T , Roseth A , Geir Larsson , Keshavamurthy S R 
Published: June 2020

Background: Necrotizing enterocolitis (NEC) is a neonatal emergency that affects preterm newborns during the 1st weeks of life. Diagnosis is made mainly by clinical criteria since no specific diagnostic tests are available. Objective: The objective was to evaluate fecal calprotectin (fCal) as a biomarker of gut inflammation to predict NEC in preterm neonates. Methods: Design: Diagnostic test evaluation. Inclusion criteria: 102 preterm neonates <36 weeks gestation and within 7 days of birth admitted in Level III neonatal intensive care unit (NICU) were recruited from January 2010 to May 2011. Exclusion criteria: Congenital anomalies and overt infection. Paired stool samples at day 3 and 7 were analyzed by lateral quantum blue rapid calprotectin assay. Cut-off values of fCal were determined among 30 term healthy infants. A structured questionnaire which included gestational age, symptoms at admission, and modified Bell’s staging was used to record NEC episodes on day 3 and 7 of admission. Septic screen and radiological tools were done as per NICU protocol. Results: 48% were above 34 weeks gestation; 31.3% were of very low birth weight. As per modified Bell’s staging on day 3 and 7, 22 and 11 neonates had 1a or above stage, respectively. 15 had features of NEC; of these, 12 were managed appropriately and discharged and 3 died. In the receiver-operated curve with fCal >279 ?g/g as cutoff, the area under the curve was 0.652 (95% confidence interval: 0.516-0.789). Day 3 fCal levels were high in 65.7% neonates. Using NEC as outcome, sensitivity of the test was 93.3%; specificity was 39%; positive predictive value was 20.8% and negative predictive value was 97.14%. Conclusion: fCal has high sensitivity for diagnosing NEC in preterm neonates. However, further research is needed to establish its clinical usefulness.
Validity of pediatric risk of mortality score in prediction of mortality in North Indian pediatric intensive care unit
Authors: Madaan Gautam , Bhardwaj Anand Kumar , Sharma P D , Dhanjal Gurdeep Singh 
Published: June 2020

Background: The pediatric risk of mortality (PRISM) score allows assessment of the severity of illness and mortality risk adjustment in heterogeneous groups of the patients in an objective manner. It has been developed and validated mostly at pediatric intensive care unit (PICUs) of developed countries with very few reports from India. Objectives: This study was planned to evaluate the usefulness of the PRISM score and to correlate it with the mortality in patients admitted to PICU of a northern Indian PICU. Material and Methods: A prospective, observational study was conducted between January 2012 and June 2013, during which a totalof 150 consecutive cases were enrolled for the study. PRISM score was calculated within 24 h of their admission and receiver operating characteristic (ROC) curve was used to establishing the validity of the PRISM score for predicting the mortality. Results: Overall mortality was 12.5%, and the PRISM score for survivors versus non-survivors was 7.5878 ± 5.032 versus 20.63 ± 3.41, respectively. No difference was seen between the observed and expected value of mortality calculated from PRISM score (Z = 0.467-1.521, p = 0.291– 0.64), thereby establishing the validity of the PRISM score in predicting the mortality in our PICU (ROC curve - area under the curve 0.934). The observed and expected values of the mortality were more comparable for lower PRISM scores (0-15) and a PRISM score of 13.5 has the highest sensitivity and specificity. Conclusion: We concluded that PRISM score is a valid parameter to predict the mortality among the ICU patients in Indian set ups.
Determinants of retinopathy of prematurity: A prospective observational study from Tertiary Care Teaching Hospital from North India
Authors: Gupta Ashok K , Pandita Neerul , Gupta Surbhi , Sharma Ashok K 
Published: June 2020

Objective: This prospective observational study was designed to evaluate the point prevalence as well as various risk factors associated with retinopathy of prematurity (ROP) in preterm/low birth weight (LBW) babies <32 weeks of gestation and or birth weight ?1500 g on both inborn and outborn babies. Materials and Methods: Binocular opthalmological examination was performed 4-6 weeks postnataly under local eye anesthesia in 200 newborns who qualified the above criteria. If ROP was detected, the 2nd evaluation was done after 1 week, 3rd evaluation after 2 weeks and 4th after 4 weeks. The examination was carried out by the same ophthalmologist. Results: 25 (12.5%) out of 200 babies developed ROP. 23 were in Stage 1 and 2 in Stage 2 at first evaluation. All showed regression, i.e., they had completed temporal vascularization on repeat follow-up evaluations. No baby showed progression to threshold stage at any time of follow-up examinations. On multiple logistic regression analysis, factors having significant association with development of ROP werebirth weight (p = 0.0028), oxygen therapy (p = 0.0059), septicemia (p = 0.0062), and blood transfusion (p = 0.0013). Conclusion: In our study, point prevalence of ROP was 12.5 % (25/200) which is substantially high among preterm/LBW babies. Thus, evaluation for ROP should be done mandatorily in all preterm/LBW babies, particularly with gestation <32 weeks and or weight ?1500 g and when risk factors are present, so as to prevent the long-term morbidity which ranges from mild myopia to blindness.
Clinico biochemical profile of birth asphyxia in neonates of western Odisha
Authors: Shah Seema , Mishra Pramila Kumari , Goel Anil Kumar 
Published: June 2020

Background: Perinatal asphyxia contributes to almost 29% of neonatal deaths in developing countries as most of the deliveries occur in rural areas and are unattended. The outcome of most of the deliveries is not encouraging in spite of standard guidelines. Objectives: To study the different spectrum of clinical presentation of birth asphyxia and its biochemical derangements. Materials and Methods: This was a prospective, hospital-based study conducted from September 2005 to March 2008 comprising of 58 term neonates admitted to neonatal intensive care unit with definite history suggestive of perinatal hypoxic insult. Compilation of history, clinical features, and relevant investigations (random blood sugar, serum creatinine, blood urea and serum electrolytes) were done, and the results were analyzed by using Medcalc software version 12. Results: Vaginal delivery was more common across all the stages. Abnormal neonatal reflex was a common feature in all babies except hypoxic-ischemic encephalopathy (HIE) I. Convulsion, mostly multifocal seizures was present in allHIE II babies where as only 22.2% babies had seizure in HIE III. Congestive heart failure (55.17%) and Oliguria was present in HIE III (77.8%) and 22 cases (37.9%) developed acute kidney injury. Hypoglycemia was observed with increasing severity of asphyxia (HIE III 26.67 ± 2.78). Serum urea, creatinine and potassium increased significantly in HIE III whereas calcium and sodium were decreased. Conclusion: The combination of clinical and supportive laboratory parameters can be used for monitoring of patients to guide early intervention to decreases morbidity and mortality.
Knowledge attitude and practices of pneumococcal vaccines in India
Authors: Kumar R Kishore , Suma A R 
Published: June 2020

Introduction: Pneumococcal conjugate vaccines (PCV) have revolutionized the prevention of invasive pneumococcal disease (IPD) globally. The initial 7-valent (PCV7) vaccine has gradually been replaced by higher valency vaccines such as PCV10 and PCV13, as these cover additional serotypes causing increased immunization. Objective: The purpose of this study was to determine the overall attitude and practices of the Indian public toward PCV for their infants. Materials and Methods: Data were collected over a period of 18 months from a tertiary perinatal center. Pneumococcal vaccine leaflets with current, unbiased information on PCV10 and PCV13 were circulated to parents, who were then asked to opt for either one or none of the vaccines for their infants at their 6 weeks immunization check-up. Results: A total of 3406 infants came for follow-up. Among them, 84% chose to give the PCV while the remaining 16% opted out. Among the parents that opted for the vaccines, 90% chose PCV13 over PCV10. This may be attributable to its increased immunogenicity and broader serotype coverage as understood by the parents - who seem to want the best for their children. Conclusion: PCV13 was a preferred vaccine of choice for infants by majority of the parents, as compared to PCV10. Such information is of valuable importance in deciding which vaccine to go for if and when India goes for PCV in the future with Global Alliance for Vaccines and Immunization and United Nations Children’s Fund funding.
Acquired demyelinating disorders of central nervous system
Authors: Dekate Parag Shankarrao 
Published: June 2020

Acquired demyelinating disorders of central nervous system (CNS) are rare disorders in the pediatric age group and are characterized by demyelination occurring at various sites in the nervous system. Demyelination can involve an isolated CNS site such as brain, spinal cord (transverse myelitis) and optic nerves (optic neuritis) or can involve multiple areas of the nervous system. This group of disorders includes transient single-time events like acute demyelinating encephalomyelitis (ADEM) to life-long conditions like multiple sclerosis (MS). Repeated acute episodes of demyelination may be a harbinger to the development of chronic demyelinating disorders. Early and accurate distinction between transient acute single-time demyelinating events and chronic relapsing conditions like MS is of paramount importance as treatment protocols and prognosis are widely different. Early disease modifying therapy may be beneficial in MS to suppress the ongoing and future relapses, whereas in ADEM, only short-term steroid therapy is all that is needed with an overall good prognosis.
The effects of stimulant medications on children’s growth velocity
Authors: Siddiqi Siraj , Dedlow E Rosellen , Saliba Heidi , Black Erik W , Giordano Beverly P 
Published: June 2020

Objective: This study sought to determine whether relationships exist between stimulant medications and children’s growth velocity. Methods: The investigators conducted a retrospective review of 280 charts of pre-pubertal children with attention-deficit hyperactivity disorder (ADHD) who were prescribed stimulant medications for a minimum of 1 year. The children were patients in a university child development/ADHD clinic. Results: The average growth velocity across all genders and ages was 5.72 cm/year (females 5.53 cm/year,males 5.28 cm/year). The majority of the children had growth velocities in the 25-50th percentiles for age. Conclusion: This study did not find evidence of significant effect on growth velocity in children with ADHD treated with stimulant medications. Our results concur with the majority of other studies of growth in children taking stimulant medications for ADHD management. It supports our continued prescription of stimulant medications without concern for slowed or stunted growth in our patients with ADHD.
Prevalence of thrombocytopenia and its relation with WHO clinical and immunological staging among human immunodeficiency virus-infected children
Authors: Kumar Durgesh , Kumar Dinesh , Singh Dharmendra Kumar , Rai Ruchi 
Published: June 2020

Objective: The aim was to study the thrombocytopenia in human immunodeficiency virus (HIV) infected children and its relation with WHO clinical and immunological HIV/AIDS staging. Study Design: Observational analytic cross-sectional study. Materials and Methods: 47 ambulatory and clinically stable HIV-infected children (confirmed by enzyme-linked immunosorbent assay for HIV-1 and HIV-2) aged 18 months-18 years attending the out-patient Department of anti-retroviral therapy center at tertiary care setting, were included in this study. Detailed history was taken, and thorough clinical examination was done in all cases. Blood samplefor complete blood count and CD4 count was taken. Primary Outcome: Thrombocytopenia in HIV-infected children. Secondary Outcome: WHO clinical and immunological HIV/AIDS staging in HIV-infected children and its relation to thrombocytopenia. Results: Of 47 studied children, thrombocytopenia was found in 14 (29.78%) cases. Patients with thrombocytopenia were found in all stages of the disease; however, it was strongly associated with increasing immunological stages (correlation coefficient, r = 0.948). Conclusion: Thrombocytopenia commonly occurs in children with HIV and its occurrence increases with an increase in WHO clinical and immunological HIV/AIDS staging.
Tuberous sclerosis complex: Role of radiology as an invaluable tool in management and follow-up
Authors: Sharma Shashi , Sharma Sandeep , Ramchandran Priya , Sharma B B 
Published: June 2020

Tuberous sclerosis complex is a genetic disorder, which affects many organs in the body manifesting spectrum of symptomatology. The severity of the disease can be gauged from the extent of involvement of a particular system. Since the disease runs a long course from its presentation at childhood till adulthood and hence the monitoring is very important to have some qualitative life. Other than the common symptomatology and a few laboratory tests, radiological investigations viz. ultrasound, color Doppler sonography, computedtomography and magnetic resonance imaging play a major role in follow-up for the management map road and associated complications. We present a case where a female child had a follow-up from the age of 8 years till 20 years of age. The follow-up and the management were designed mainly as per the radiological findings. The radiological findings have indicated the time for the patient to undergo surgical intervention in addition to the ongoing medical management.
A rare cause of recurrent pneumonia: Scimitar syndrome
Authors: Murthy Srinivas , Raghavendra K , Pejaver Rajath , Basavanthappa S P , Kumar Naveen 
Published: June 2020

Scimitar syndrome is characterized by partial or total anomalous pulmonary venous return from the right lung along with hypoplasia of the lung. This syndrome has varied presentations, from an asymptomatic state to severe pulmonary hypertension and/or heart failure. Newer diagnostic modalities have improved our understanding of this rare syndrome and hence providing newer treatment options to be tried. Here, we present a case of a 4-year-old child with recurrent pneumonia with Scimitar syndrome. We are reporting this case in view of the rarity of this syndrome and its presentation as recurrent pneumonia.
Mongolian spot with involvement of the frontal area
Authors: Leung Alexander K C , Barankin Benjamin , Hon Kam Lun 
Published: June 2020

Mongolian spots are congenital hyperpigmented macules of varying size and shape and are usually grayish in color. They occur commonly in the sacrococcygeal area, followed by the gluteal and lumbar areas. We report a Chinese infant with a Mongolian spot in the frontal area; the occurrence of a Mongolian spot in this location is considered exceptional. Awareness of such an occurrence is important, and hence that a false accusation of child abuse is not made.
Tyrosinemia type 1: A case report
Authors: Prabhakar Shashikala , Banu Nasima , Meghana S 
Published: June 2020

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

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

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

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

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

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