Amar Taksande

Congenital malformations at birth in Central India: A rural medical college hospital based data.

OBJECTIVE: To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra. MATERIALS AND METHODS: All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable. RESULTS: Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies. CONCLUSION: Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers’ babies is the important factor to be considered.

Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India.

Objectives: To study the blood pressure of school going children in a rural area and its relationship with the anthropometric indices. Methods: A prospective, cross-sectional study was carried out from November 2006 to December 2007 in the school going children between the ages of 6–17 years from eight different schools in the rural areas of Wardha district. The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in both sexes followed by complete clinical examination with special emphasis on cardiovascular system. Hypertension (HT) was defined as SBP or DBP exceeding the 95th percentile for age, gender, and height on at least three separate occasions, 1–3 weeks apart. SPSS software was used to analyze the data. Coefficient correlation tests were employed to assess the relation between BP and anthropometric variables. Results: Of 2643 school children, 1227 were boys and 1416 girls with a male to female ratio of 1:1.16. In boys, SBP and DBP increased with age except a marginal decline in SBP at the age of 17 years (−0.09) and decrease in the DBP (−1.29) at 16 years of age. In girls, SBP and DBP also increased with age except at 11 years, wherein there was a mild decrease in SBP (−0.09) as well as the DBP (−0.24). Correlation coefficient analysis showed highly significant positive correlation of height with SBP and DBP. There was a significant correlation of SBP and DBP with the weight, and body mass index (BMI). The prevalence of HT was 5.75% (i.e., 3.25% for systolic HT and 2.49% for diastolic HT). Conclusion: We recommend that there is a need for checking BP to detect HT in children, so that remedial measures can be initiated as early as possible.

Pain response of neonates to venipuncture

Objective: To study the physiological and behavioral response to pain.Methods: 80 healthy neonates requiring bilirubin estimation, blood sugar etc. were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR., HR, NIBP and 02 saturation observed on Datex-Ohmeda multimonitor.Results : After the venepuncture, heart rate (p<0.001 ) and blood pressure (p<0.001 ) were significantly increased in both the groups but more significant increase was present in Group l(>2.5kg) as compared to Group II (>2.5kg). Respiratory rate was also increased but more significant in Group II(p<0.001) whereas Oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001 ).Conclusion : The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.

Primary pyomyositis in a child

Pyomyositis is a term used to denote primary pyogenic infection of the skeletal muscle. Striped muscle tissue is normally resistant to bacterial infection; pyomyositis is very rare. Primary pyomyositis is a purulent infection of striated muscle that is thought to be caused by seeding from a transient bacteremia. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided by either a computed tomography or magnetic resonance imaging scan. If the patient does not respond quickly to antibiotics and surgical intervention, there is either a recurrence of the previously debrided abscess or an unrecognized secondary abscess. Here, we present a case of primary pyomyositis of the iliacus muscle that might be due to severe pneumonia in a five-year-old child.

Peak expiratory flow rate of rural school children from Wardha district, Maharashtra in India

BackgroundPeak expiratory flow rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children. The PEFR can be measured by a simple instrument—peak expiratory flow meter. The aim of this study was to determine the normal PEFR in rural school children from Wardha district of Maharashtra state, India.MethodsThe PEFR was measured in 1078 healthy rural school children, living in Wardha district, Maharashtra using the Mini-Wright peak flow meter. All measurements were obtained in a standing position and the best out of three trials was recorded. Anthropometric measurements, weight, height, and mid-upper-arm circumference (MAC) were recorded, and body surface area (BSA) and body mass index (BMI) were calculated.ResultsPositive correlation was seen between age, height, weight and PEFR. The regression equations for PEFR were determined for boys and girls separately. The boys had higher values than the girls at all heights. The prediction equation for PEFR based on height was PEFR = 3.64 height (cm) − 257.86 (R=0.47, R2=0.22) for female; PEFR = 4.7 height (cm) − 346.51 (R=0.62, R2=0.38) for male.ConclusionPEFR is a reliable measurement, which can be used routinely and regularly in rural areas for assessment of airway obstruction and prediction formula derived for use in this population.

Knowledge and attitudes of Anganwadi supervisor workers about infant (breastfeeding and complementary) feeding in Gondia District.

Breastfeeding promotion is a significant child survival strategy. Interventions to improve early and correct infant feeding practices can result in considerable reduction in neonatal morbidity and mortality. A supervisor provides continuous on-the-job guidance to Anganawadi workers (AWWs), to bridge the gap between training and job requirement. Each supervisor looks after 10 Anganawadis and each Anganawadi covers a population of approximately 1000. On her visit to Anganawadi, the supervisor performs certain important tasks like: i) Checks the list of beneficiaries from the low economic strata, who are severely malnourished, ii) Guides AWWs in the assessment of correct ages of children, correct method of weighing the children, and plotting their weights on growth charts, iii) Demonstrates to the AWWs the effective methods of providing health and nutrition education to mothers, and iv) Maintains the statistics of the Anganawadis.(1) Her work includes health and nutrition education on various aspects of the health of a mother and child. Therefore, it is important for the supervisor to have adequate scientific knowledge about infant breastfeeding. This will help her to impart correct knowledge to mother beneficiaries (pregnant, lactating mothers, and women in the reproductive age group).(2,3) The objective of the present study is to assess the knowledge (scientific and latest) and attitude of the Anganawadi supervisors with regard to infant feeding and also to identify gaps in their knowledge.

Wildervanck syndrome with hypoplastic frontal sinus: A rare case presentation.

We report a case of Wildervanck syndrome exhibiting Klippel–Feil anomaly, Duanes retraction syndrome and congenital deafness. Since the first case was reported in 1952, there have been more reports describing this triad either complete or incomplete. Our case has a complete triad of the syndrome along with frontal sinus hypoplasia. Our case is unique as the triad was associated with frontal sinus hypoplasia, which is very rare association.

Pulmonary and aortic stenosis measurement in Williams–Beuren syndrome

1. The authors have stated that supravalvular aortic stenosis (SVAS; n = 15) was diagnosed by echocardiography or cardiac catheterization as a localized or diffuse narrowing of the ascending aorta associated with a pressure gradient equal to more than 10 mmHg. The author has not mentioned the aortic orifice area, which is very important, and the classification of the aortic stenosis on the basis of pressure gradient. It is on the basis of classification that we can decide which patient needs balloon valvuloplasty and which does not (2). Similar with valvular pulmonary stenosis (PS; n = 10) also. 2. The statistical method and software used was not mentioned. 3. The distribution of cardiac anomalies (n = 51) including (SVAS = 15, PS = 10, peripheral pulmonary stenosis = 12, mitral valve prolapse = 9, coarctation of aorta = 4, ventricular septal defect = 2, atrial septal defect = 1) patients of Williams–Beuren syndrome (n = 20) is not very well understood. 4. The authors have not mention about the type, management and outcome of the acyanotic shunt lesion (i.e. ventricular septal defect, atrial septal defect).

Acute acalculous cholecystitis: A rare complication of typhoid fever in an 18-month child

Enteric fever is rare in children aged under 2 years. Acute acalculous cholecystitis is inflammation of the gallbladder in the absence of gallstones, and is a very rare complication of enteric fever. Here we describe an 18-month-old boy presenting with fever, vomiting, and abdominal pain who was found to have acute acalculous cholecystitis due to typhoid fever on basis of ultrasonographical findings and a positive widal test. He was treated with parental antibiotics and made a full recovery without undue complication.

Re: Van Bogaert LJ, Misra A. 2008. Neonatal outcome after caesarean birth for fetal distress and/or meconium staining in a South African rural setting. Journal of Obstetrics and Gynaecology 28:56–59

Dear Sir, We read with interest the paper by Van Bogaert and Misra (2008) on neonatal outcome after caesarean birth for fetal distress, and make the following comments. Meconium staining of the amniotic fluid is typically but arguable equated with fetal hypoxia. Intrauterine distress can cause passage of meconium into the amniotic fluid. If the meconium stained baby is not vigorous at birth, it will be necessary to intubate the trachea to clear before the baby takes its first breaths. If the meconium stained baby is vigorous, suctioning the trachea is not necessary. The author mentioned in the discussion that meconium aspiration must be prevented by proper suction of the upper airway before delivery of the shoulders, followed by suction under vision of the oropharynx, endotracheal intubation to suction the lower respiratory tract and gastric aspiration to prevent the delayed meconium aspiration from regurgitation. Previously, we also used to practise the same, the intra-partum suctioning before the delivery of the shoulder to clear meconium from airway, before the baby took a breath. Recently, the multicentre, randomised controlled trial study by Vain et al. (2004) concluded that there were no differences in the incidence of MAS, need for mechanical ventilation and mortality between suction and no suction group. Intrapartum suctioning has potential risks such as apnoea, cardiac arrhythmias triggered by pharyngeal stimulation, worsening hypoxia, delay in resuscitation and damage to upper airway. Currently, the new guidelines are that the routine intra-partum oropharyngeal and nasopharyngeal suctioning is not recommended for prevention of MAS in infants born with MSAF (ACOG, Committee on Obstetric Practice 2007).