Amit Devgan

Translating technology into patient care: Smartphone applications in pediatric health care

The latest generations of smartphones are increasingly viewed as handheld computers rather than as phones and the applications on these phones are becoming increasingly popular among the medical professionals. A large number of health care applications are available across various smartphone platforms. At times it may be difficult to identify most appropriate and reliable application for use at the point of care. In this review, we have tried to identify the applications relevant to Pediatrics and Childcare which when used at the point of care might be helpful in improving patient care.

Prevalence of rotavirus infection in children below two years presenting with diarrhea

BACKGROUND Rotavirus is a common cause of diarrhea in children. There is a need for data on prevalence of rotavirus diarrhea especially in our setting. This study was carried out to determine the prevalence of rotavirus infection in children upto two years presenting with diarrhea and to ascertain factors associated with rotavirus infection in them. METHODS A cross sectional observational study was carried out to determine the prevalence of rotavirus infection amongst children less than 2 years presenting with diarrhea. The clinical profile of the children was analyzed along with detection of rotavirus antigen in stool. RESULTS A total of 250 children with diarrhea were included in the study. The Male: Female ratio was 0.97:1. We found 24% children presenting with diarrhea to be positive for rotavirus antigen. 78.3% of children with rotaviral diarrhea were in the age group of 6-15 months. There was a significant association between type of feeding and rotavirus diarrhea with reduced prevalence while on exclusive breast-feeding. Though only 10.4% of children with rotavirus diarrhea had severe dehydration, 61.5% of children with severe dehydration were positive for rotavirus. CONCLUSION Rotavirus diarrhea caused substantial morbidity in our study population. The rotavirus positivity in these children was 24% and there was a significant association of rotavirus infection with type of feeding and severity of dehydration.

Effects of maternal epidural analgesia on the neonate - a prospective cohort study

BackgroundEpidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase.MethodsA prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation.ResultsThere was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia.ConclusionsEpidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

Gaucher's disease: rare presentation of a rare disease.

Gaucher’s disease is a rare lysosymal storage disorder characterized by deposition of glucocerebroside in cells of the macrophage monocyte system. Gaucher’s disease has 3 types—non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). It generally presents with delayed milestones, seizures, bony deformities, or massive organomegaly. The acute neuronoapthic variety is the rarer type that predominantly presents with neurological features. The authors present a case of the acute neuronopathic variety of Gaucher’s disease where the child presented with only abnormal head position.

Varied presentations of hypothyroidism in children.

Hypothyroidism is among the most common endocrine disorders in children. Congenital hypothyroidism is reported to occur with an incidence of 1:2640 live births in India,1 and the most common cause is thyroid dysgenesis. Acquired hypothyroidism in children is less common, and in a hospital based study of 100 hypothyroid children in a developing country, only 9% were acquired.2 Hypothyroidism is an endocrine disorder of varied clinical presentation. Manifestations range from subclinical hypothyroidism, which requires high index of suspicion for diagnosis to myxoedema coma. There may be situations where in a given patient an alternative diagnosis may explain the clinical features, and hypothyroidism may be missed. We report four such cases of cryptic hypothyroidism, which we encountered in different clinical situations.

Parameatal urethral cyst

Parameatal urethral cyst is a rare clinical entity, resulting in asymptomatic cosmetic concerns, distortion of urinary stream or difficulty in urination. Though they cause considerable parental concerns, natural history is to resolve spontaneously or rarely surgical excision is needed. We report a neonate with asymptomatic parameatal urethral cyst.

Non-traumatic rupture of eventration of diaphragm in a child

Eventration of the diaphragm is a rare condition where the diaphragm is permanently elevated, but retains its continuity and attachments to the costal margins.1 This condition affects less than 0.05% of general population and is more common in males.2 Rupture of eventration of diaphragm, which is extremely rare in a child, can be either traumatic or spontaneous.3, 4, 5, 6, 7, 8, 9 As there is paucity of literature of spontaneous rupture of eventration of diaphragm in children, we report a child with non-traumatic rupture of eventration of diaphragm.

Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells

Background Iron deficiency anemia (IDA) in cyanotic congenital heart disease (CCHD) and its association with cyanotic spells has been documented in literature. However, Indian data especially in the pediatric age group is scarce. This study was conducted to find out the prevalence of IDA in this population. Methods An observational study was conducted in a tertiary care hospital. Children with CCHD in the age group of birth-12 years were included in the study. Hematological parameters of these patients were determined and compared. An assessment of the incidence of cyanotic spells in the iron-deficient and iron non-deficient children was also done. Data analysis was done using Fischers exact test. Results The prevalence of IDA was 47.06% in the study population. The study also showed that hemoglobin and hematocrit levels were paradoxically higher in the iron-deficient group as compared to the non-deficient, though the iron studies revealed the iron deficiency. The incidence of cyanotic spells was higher in the iron-deficient group. The mean corpuscular volume (MCV), red cell distribution width (RDW), serum ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) values were the parameters, which were found to be statistically significant to differentiate the study groups. Conclusion The prevalence of IDA in children with CCHD was found to be high. Iron-deficient group had an increased frequency of cyanotic spells as compared to the non-deficient group, which was statistically significant.

A rare case of hypercholesterolemia in a young girl.

Familial hypercholesterolemia though recognized in children is rarely reported with severe manifestations in early childhood. We report a child who presented with xanthomas with hypercholesterolemia at age of 7 years. She was put on statin therapy but in next 3 years had rapid progression of disease with development of severe valvular and supravalvular aortic stenosis, coronary artery disease and diffuse narrowing of descending thoracic aorta.

LOW BIRTH WEIGHT BABIES : INCIDENCE AND RISK FACTORS

In a prospective hospital based study, during the period from Jan 95 to Dec 96, 3100 consecutively delivered live newborns were studied for the incidence of low birth weight neonates and to evaluate the associated risk factors. One thousand fourteen newborns were classified as low birth weight babies. The incidence expressed per 1000 live births was 327 (32.7%). Of these, 815 (80.4%) were small for gestational age neonates and 199 (19.6%) were preterm neonates. Five hundred seventy small for gestational age neonates (70%) were weighing between 2001 to 2500 gms. Mothers belonging to the age group of 19-25 years delivered the maximum number of low birth weight babies (618/1014) and of these 82.8% were small for gestational age neonates. There were 48 neonates with low birth weight born to mothers below the age of 18 years. Primiparous mothers were found to contribute higher number of low birth weight neonates (414/1014). Spacing as a factor did not show any major difference. Two hundred sixty two low birth weight neonates were born to mothers with significant obstetrical problems such as pregnancy induced hypertension, bad obstetrical history and premature rupture of membranes. The incidence of 32.7% of low birth weight babies is high enough to ring alarm bells.