bluuebunny/crossref_metadata_2025_split 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.
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.
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.
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.
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.
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.
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.