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   Table of Contents - Current issue
January-March 2020
Volume 9 | Issue 1
Page Nos. 1-45

Online since Friday, November 6, 2020

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nCOVID-19 – Pralaya raised by mother nature to punish erring Homo Sapiens or the low-cost biological warfare by humans to conquer world? p. 1
Nimain C Mohanty
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Impact of air pollution, climate change, and nutrition on airway allergic diseases p. 4
H Paramesh
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Pediatric COVID-19: Revision before resumption p. 7
Surabhi Chandra
With staged unlocking, physical opening of classes and schools is not distant. There is an urgent need to revise all salient points of this infection in children. Infection spreads mainly via droplets, fomites and contact with infected surfaces even though feco-oral route of transmission has also been reported. Majority of cases are asymptomatic or have mild illness. Children who have been diagnosed as positive usually have familial clustering. A positive history of exposure and clinical symptoms are more helpful for screening. Confirmation of the diagnosis is on the basis of a positive RT-PCR. Most common symptoms having been reported are fever and cough. Complete blood counts are suggestive of leucopenia with relative lymphopenia. Management of COVID 19 in children is primarily supportive. Prevention is the key to successful outcome in patients with COVID-19
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Ascaris lumbricoides-induced small bowel obstruction; Experience from a tertiary care center p. 10
Raashid Hamid, Adfar Shah, Nisar A Bhat, Ajaz A Baba, Gowhar Nazir Mufti, Khursheed A Sheikh
Introduction: Ascaris lumbricoides induced intestinal obstruction is a sequel of this parasitic infestation. It presents as colic, vomiting (bilious or nonbilious), abdominal distention, and at times peritonitis. Management includes indoor admission, intravenous fluids, rectal enemas, and serial clinical and radiological assessment for detecting any indication of surgery. We, in our study, we analyzed the outcome of conservative management and the use of oral administration of 76% gastrograffin. Materials and Methods: Clinical parameters of all these patients were recorded and kept under close monitoring of the clinical parameters. Patients were initially subjected to conservative treatment whereby patients were advised nil per oral, nasogastric tube aspiration, intravenous fluid, rectal enemas, and antibiotics as indicated. In some patients, without signs of peritonitis and severe obstruction, contrast agent Gastrograffin was administered either per oral or vie6a nasogastric tube. Serial abdominal radiographs were taken. Surgical intervention was performed if worms were not expelled after 48–72 h of conservative treatment or contrast gets held up after 24–36 h in small intestines or clinical deterioration. Data were analyzed statistically. Results: A total of 240 patients were included in this study. The abdominal pain 156 (65%) was the most common symptom followed by distension in 168 (70%). Among patients, 65% were boys (n = 156) and 35% girls (n = 84). The clinical signs included abdominal distention in 168 (70%), tenderness in 28 (11%), rigidity 34 (14%), palpable worm masses in 115 (48%), and visible gut loops in 29 (23%). Most of the patients 204 (85%) responded to conservative management. Among 36 patients who needed surgery, 10 patients had received oral contrast. The peroperative findings included-impacted worms in 14 cases, impacted worm mass with gangrene 6 cases, intussusceptions without gangrene 7 cases, and gut volvulus with gangrene in 9 cases. The average hospital stay was 4.40 ± 2.25 days in cases managed conservatively, whereas about 10.35 ± 6.24 days in cases needing surgical intervention. There was no mortality in our series. Conclusions: Ascaris-induced worm obstruction should be managed conservatively; surgery is indicated if conservative management does not result in clinical improvement. The addition of Gastrograffin orally in some patients without complete obstruction significantly decreases the hospital stay and reduces the time period between admission to the expulsion of the worms.
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Study on the pattern of adverse events following immunization in children aged ≤6 years: A single-center experience p. 15
Manohar Badur, Subramanyam Pujari, Mrudula Yenepalli, Latheef Kasala, Rishika Jayachandra Chintham
Objectives: This study was conducted to observe the incidence of adverse events following immunization (AEFI) in children ≤6 years of age. Material and Methods: An observational study was conducted in the department of pediatrics of our hospital from November 2018 to November 2019. A total of 20,414 children who attended the well-baby clinic for immunization over a period of one year were enrolled and observed for adverse events. Parents of the children were telephonically contacted for the observation of any type of adverse reaction that has followed by the administration of the vaccine. Results: Among 20,414 children, 8246 AEFI were reported during the study period. Majority of the AEFI were reported in the age group <1 week, followed by 6 weeks. Female children (56.7%) had reported more AEFI compared to male children (43.3%) with a ratio of 1.3:1 (F:M). The most common AEFI reported was fever (n = 4195 cases), followed by swelling (n = 2933 cases). Penta + IPV + OPV + Rota (38.2%) was majorly responsible for AEFI, followed by BCG + Hep-B + OPV (35.5%). Most of the AEFI (93.3%) were reported within 1 day of vaccine administration (n = 7691 cases). Conclusion: Our findings revealed that most of the adverse events were observed on day-1 after vaccine administration. Thus, after identifying the vaccines responsible for adverse events and the characteristics of the events, we may continue to consider vaccines as safe biological products. We also recommend that all AEFI should be documented and reported to the Central Drug Standard Control Organization (CDSCO) in real-time regarding vaccine use and awareness of vaccine safety.
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A study on association of indicators of iron deficiency with febrile seizure in children admitted in pediatric emergency ward p. 20
Kamirul Islam, Asok Kumar Datta, Atanu Roy, Rajib Das, Suman Saha, Soutrik Seth
Objectives: Febrile Seizure is the most common form of seizure in childhood. There are conflicting evidence regarding the association between iron deficiency and febrile seizure. Hence, this study was undertaken to find out the association between different indicators of iron deficiency with febrile seizure in children admitted in the Pediatric Emergency Ward of Burdwan Medical College, Burdwan. Methodology: A total of 159 children were selected by the complete enumeration method. Parameters of iron deficiency were estimated in them and age, sex-matched controls. Mann–Whitney U test and Spearman's rank-order correlation coefficient were used to find out the association between indicators of iron deficiency with febrile seizure. The binary logistic regression method was used to find out the adjusted odds ratio. P < 0.01 was considered statistically significant. Results: About 53.5% of the study population (mean age: 3.01 ± 1.37 years) was male. Mean hemoglobin, serum iron, serum ferritin, mean corpuscular volume, and mean corpuscular hemoglobin concentration were significantly higher in the control group, while the reverse is true for serum total iron-binding capacity. Serum ferritin became the most significant parameter, responsible for 57.3%–76.4% variability of febrile seizure. Overall, our model correctly predicted 50% variance of the dependent/outcome variable. Conclusion: Iron deficiency is more common among children with febrile seizure. Hence, iron prophylaxis may be given to children with febrile seizure. Further research (preferable multi-centric) should be conducted.
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Assessment of risk factor associated with down syndrome p. 24
Amandeep Kaur, Anupam Kaur
Introduction: A large number of Down syndrome (DS) children are born every year in India and are the leading cause of morbidity and mortality in infants. The aim of the present study was to evaluate the possible risk factors in mothers for having DS. Methodology: A total of 217 DS cases were collected, and lymphocyte culturing was performed to confirm aneuploidy. Mothers having DS children (n = 213) with confirmed trisomy 21 and age-matched controls (n = 220) with normal children were collected. Results: Of 217 cases, 213 had confirmed trisomy 21 in children, and free trisomy 21 was observed in 91.71%, followed by mosaics in 3.68% and Robertsonian translocations in 2.30% of the cases. A double aneuploidy with chromosomal constitution 48, XXY,+21 (0.46%) was also seen. The mean maternal age in cases was 27.34 ± 5.2 years, while in controls, it was 27.75 ± 4.9 years. Logistic regression analysis showed that intake of folic acid (P < 0.0001) was associated with reduced risk while decreased parity (P = 0.01), intake of drugs in mothers (P = 0.002), and alcohol intake in fathers (0.032) were significantly associated with an increased risk of a DS child. Nearly 30.62% of the mothers experienced miscarriage before the birth of DS child but was not associated with an increased risk of trisomy 21. Conclusions: DS children were born to mothers younger than 30 years; intake of folic acid significantly reduced the risk, while intake of drugs in mothers and intake of alcohol in fathers significantly increased the risk of a DS child.
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Profile of scorpion sting in children admitted in the pediatric intensive care unit p. 31
Anshul Bhargava, Sweekar Panchal, Suhas Kharche, Jeetendra Gavhane
Introduction: Venomous scorpion sting is a medical emergency. The clinical manifestations vary widely between the children and adult group. Aims: The aims of the study were to study the profile of scorpion sting in children admitted in the pediatric intensive care unit (PICU). Materials and Methods: Sixty-one cases of scorpion sting admitted in PICU of MGM Medical College were studied. A detailed history was taken, and a thorough clinical examination was done in all patients. All patients with cold extremities, sweating, and tachycardia were given prazosin. Patients with features of shock were treated with oral prazosin plus dobutamine. Patients with features of shock and myocarditis were treated with prazosin plus dobutamine plus antiscorpion venom therapy. Results: Of 61 cases enrolled in our study, scorpion sting was more common in monsoon followed by summer season. The sting was more prevalent in the lower limb. The most common symptom was pain followed by cold extremities. Dyspnea due to pulmonary edema and bradycardia were less common. Tachycardia was frequently noted (80%). Two patients presented after 12 h had developed pulmonary edema and died. Conclusion: Prazosin had good outcomes in all patients with scorpion sting when administered at the time of admission. The study throws light on the common clinical features and complications of scorpion sting.
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An analysis of outcome of pediatric hydrocephalus: A 10-year study from Central India p. 33
Roshan Chanchlani
Introduction: Ventriculoperitoneal (VP) shunt is an easy and inexpensive procedure done for the management of hydrocephalus all over the world. However, it is associated with several complications and morbidity. Objectives: The objective of this study was to assess the outcome of children having hydrocephalus who underwent VP shunt. Methods: In this retrospective study, records of 196 children who were operated for hydrocephalus by a single surgeon were analyzed and the spectrum of complications was noted. This 10-year study was conducted from May 2010 to April 2020, and the patients were operated in various hospitals and tertiary care centers in Bhopal city, Madhya Pradesh, India. Results: Out of the 196 patients, 120 were boys and 76 were girls. In this series, 130 (66.3%) patients were <1 year of age. The median age was 20.7 months (range 1.4 months to 9.5 years). Aqueductal stenosis (35.7%) was the most common congenital and tubercular meningitis (16.3%) was the most common acquired cause of hydrocephalus. Vomiting (18.4%) was the most common symptom and enlargement of the head (40.8%) was the most common sign. Common indications for shunt revision were shunt obstruction (10.2%) and shunt infection (6.6%). In this study, most of the shunt failures (20, 47.61%) were seen within 3 months of surgery. Mortality in this series was 12.8%.Conclusions: Of the 196 children who underwent VP shunt for hydrocephalus over a period of 10 years, 12.8% died, 10.2% had shunt obstruction, and 6.6% had shunt infection. Complications of shunt procedures adversely affect the final surgical outcome. Cerebrospinal fluid shunting features a propensity for mechanical failure, and patients with VP shunts should receive regular follow-up through the transition to adulthood.
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Multiple tuberculoma and choroid tubercles in a child with miliary tuberculosis p. 38
A Sivakami, Harshita Shah, N Revati
Miliary tuberculosis (TB) is a pathological name describing millet seed-sized (1–2 mm) granulomas in the various organs affected by tubercle bacilli. Miliary TB has a spectrum of manifestations that still perplex the most erudite and experienced clinicians and is a diagnostic and therapeutic challenge. Despite effective therapy being available, mortality from this disease has remained high. In children with miliary TB, chills, night sweats, hemoptysis, and productive cough have been reported less frequently, whereas peripheral lymphadenopathy and hepatosplenomegaly are more common compared with adults. Hereby, we present a case report of multiple tuberculoma and choroid tubercles in a child with miliary TB.
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Levosulpiride-induced acute dystonia in a pediatric patient p. 41
Pradeep Reddy, Arunava Bharati, Vikram Patra, Bageshree Seth
Dystonia is a movement disorder characterized by involuntary muscle contractions. It may involve muscles of the neck, jaw, tongue, or the entire body. Dystonia could be a manifestation of an underlying central nervous system disorder or due to drugs. The list of drugs causing dystonia has been increasing as new drugs are becoming available. There are reported cases of levosulpiride-induced dystonia in adults. We report one such drug which caused dystonia in a pediatric patient due to an irrational drug prescription.
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Hypomelanosis of ito p. 43
Jonaki Pal, Atanu Roy, Asok Kumar Datta
A 1-year-old child presented with generalized tonic–clonic convulsion and delayed developmental milestones. Hypopigmented streaks were noted on the right side of the body that ended abruptly in the midline. Magnetic resonance imaging of the brain shows paucity of sulci in both parietal areas and the right-sided cerebral hemisphere larger than the left. The child is clinically diagnosed with a case of hypomelanosis of ito.
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