Chanchal Kundu

Food Supplementation as an Incentive to Improve Pre-antiretroviral Therapy Clinic Adherence in HIV-Positive Children—Experience from Eastern India

OBJECTIVE To evaluate the importance of food supplementation as incentive in improving preantiretroviral therapy (pre-ART) adherence, and second its impact on health of HIV-infected children by a clinic-based observational study. METHODS HIV-seropositive children aged between 2 and 12 years were followed-up sequentially for 2 years without and with food supplementation, respectively, with monitoring of disease parameters. The outcome morbidity parameters were compared and correlated. RESULT Study showed significant improvement in clinic adherence (r = 0.165, p = 0.027) along with increased mean clinic visit (6.65 ± 1.43 vs. 8.01 ± 1.52, p = 0.000) and mean CD4 count (p = 0.028) with incentive. Provision of incentive correlated well (Pearsons r = 0.345) with number of visits which in turn had strong correlation with weight gain (r = 0.548), episodes of AIDS-defining illnesses (r = -0.412), hospitalization (r = -0.279). CONCLUSION Food incentive could enhance pre-ART phase clinic adherence that decreases disease-related morbidities, setting the stage for improved treatment and care of seropositive children in future.

Unique Neurological Manifestations of Dengue Virus in Pediatric Population: a Case Series

Dengue infection is endemic in developing countries posing a major public health problem. Clinical manifestations form a broad spectrum and include uncomplicated dengue fever, dengue hemorrhagic fever and dengue shock syndrome. We report three confirmed cases of dengue infection in pediatric population with central nervous system involvement with certain unreported manifestations resulting in diagnostic dilemma. Increasing evidence of neurotropism by dengue virus emphasizes that clinician be aware of such association and consider dengue infection in cases of febrile encephalitis and myelitis in endemic areas. Early diagnosis and appropriate supportive cars can reverse this potentially fatal disease.

Normative blood pressure data for Indian neonates.

ObjectivesTo establish the normative blood pressure (BP) values in healthy Indian neonates using oscillometric method, and to develop BP percentile charts.DesignProspective observational study.SettingNeonatal unit of a teaching hospital in Eastern India.Participants1617 hemodynamically stable inborn neonates without birth asphyxia, major congenital anomaly, maternal complications (e.g. preeclampsia, hypertension, diabetes) or critical neonatal illness.ProcedureQuite state measurements of systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were recorded by oscillometric method on day 4, 7 and 14 of postnatal life. The averages of three readings at 2-minute intervals were used.ResultsPercentile charts (providing 5th, 10th, 25th, 50th, 75th, 95th, and 99th percentile values) have been developed. SBP, DBP and MAP showed a steady rise from day 4 to day 14, and were comparable between males and females, but were significantly lower in preterms than in term neonatesConclusionNormative neonatal BP data along with gestational age-wise percentile charts shall be of help for decision-making and planning for sick newborns.

Animal Bites and Rabies Prophylaxis in Rural Children: Indian Perspective

A prospective observational study was conducted in a tertiary care hospital to study clinicoepidemiological profile of potentially rabid animal bite cases from rural India. Total of 308 children (median age 6 years) admitted to hospital, were recruited over 1 year and followed up till completion of antirabies vaccine course. Dog was the commonest (77.27%) offending animal. Of the exposures, 66.88% were scratches, 88.96% were unprovoked and 27.27% were categorized as Class III. The median times to wound toileting and reporting to health facility were 1 and 6 h, respectively. Majority received prompt PEP in hospital, and RIG was administered in 34.55% of Class II and 90.48% of Class III exposures. Compared with their older counterparts, children aged <5 years suffered more bites on face and trunk and more Class III exposures. The rabies prophylaxis scenario is encouraging, when compared with earlier studies, but there are gaps to be addressed.

Study of blood glucose level in normal and low birth weight newborns and impact of early breast feeding in a tertiary care centre

Background and Objectives: Neonatal hypoglycemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. We designed this study to assess the incidence of hypoglycemia in healthy normal birth weight and low birth weight babies, including both preterm and small for gestational age (SGA) newborns, to evaluate the impact of early breastfeeding on hypoglycemia and to assess the impact of exclusive breast feeding on glucose values up to 48 h of age. Design and Settings: A hospital-based prospective longitudinal study. Materials and Methods: The study was conducted over six months involving one hundred fifty healthy (both term and preterm) appropriate for gestational age (AGA) or SGA babies with birth weight between 1.5 kg and 3.99 kg. Blood glucose values were measured at the age of 1 h, 6 h, 12 h, 24 h and 48 h after delivery which was independent of feeding time. Blood glucose value less than 40 mg/dl (2.2 mmol/l) was defined as hypoglycemia. Sick newborns, those less than 34 weeks of gestation or less than 1500 g, infant of diabetic mother, those with birth asphyxia, congenital malformations and endocrine deficiencies were excluded. Results: Overall incidence of hypoglycemia was 32%. Hypoglycemia was significantly greater in SGA and preterm as compared to AGA and term newborns respectively (P<0.001). Incidence of hypoglycemia was significantly more in newborns with delayed breast feeding than early breast feeding (64% vs 17%; P<0.001). Conclusion: Low birth weight babies (both preterm and small-for-date) are prone to develop hypoglycemia especially in first 24 h of life with delayed introduction of breast feeding being an additional risk.

Childhood lupus nephritis: 12 years of experience from a developing country’s perspective

Objective To assess the long-term outcome of lupus nephritis in children with systemic lupus erythematosus followed up over 12 years at a tertiary care teaching hospital in Eastern India. Material and Methods This is a retrospective observational study of the clinicopathological presentation, management, and outcome in 46 children with lupus nephritis over a period of 12 years at a tertiary teaching hospital in Eastern India. Mortality was compared between different lupus classes and therapy groups with Kaplan-Meier analysis and log-rank test. Results The incidence of lupus nephritis was 58.97% [95% confidence interval (CI) 48.06%-59.89%] with the mean age at presentation being 10.2±2.43 years (range 5.5-14.5) years. Majority belonged to class IV (30.43%), followed by class II (26.91%), class III (23.91), and class V (8.70%). Outcome analysis of children with lupus nephritis over 12 years revealed that 24 (52.17%) achieved complete remission of disease activity, 5 attained partial remission, 4 continued to have active disease, 5 developed end-stage renal disease (ESRD), and 8 died. Overall mortality thus observed was 17.39% with septicemia in the background of ESRD being the commonest cause. No significant difference in mortality was observed between different lupus nephritis classes or therapy arm groups. Conclusion The study throws light on various aspects of lupus nephritis and their long-term outcome patterns in children from developing countries such as India.

Blood pressure variation with gestational age and birth weight in Indian newborn

Prospective observational study was conducted in a tertiary care hospital of India over 8 months to measure blood pressure (BP) in healthy term and preterm neonates using oscillometric method and explore the associations with gestational age and birth weight. Consecutive BP measurements were taken by standard oscillometric method on 1617 neonates on day 4, 7 and 14 of life. Mean birth weight was 2.7 ± 0.46 kg, and mean gestational age was 38.2 ± 2.12 weeks. The mean arterial pressure (MAP) on day 4, 7 and 14 were 59.3 ± 7.33, 63.2 ± 6.55 and 66.4 ± 6.13 mmHg, respectively. Larger and mature newborns had significantly higher BP than those who were smaller and premature. Birth weight more strongly correlated with MAP than gestational age. Predictive equations linking MAP with gestational age and birth weight were deduced, which can be used for judicious fluid inotrope management.

HIV encephalopathy masquerading as infantile stroke syndrome: Treatment after antiretroviral did wonders

We present a case report of a young child with fever for 2 weeks followed by ataxia, spastic quadriparesis, aphasia with bulbar palsy, and lastly loss of consciousness. All symptoms developed within a span of 5 days. Provisional diagnosis of infantile stroke due to infective vasculitis was made. Cranial computed tomography revealed multiple infarctions with bilateral dilated ventricles and mild cortical atrophy. Based on cerebrospinal fluid analysis, contact history and Mantoux test, anti-tu bercular therapy was started. Therapeutic failure led to a suspicion of immunosuppression. So, opportunistic infections of central nervous system along with neurotuberculosis were ruled out by relevant standard tests. Subsequently human immunodeficiency vi rus encephalopathy was diagnosed and highly active antiretroviral therapy was initiated immediately. Neurological abnormalities reversed and complete radiological clearance was noted with highly active antiretroviral therapy within 1 year. The unusual presentation, rare neuroimaging findings, and dramatic res ponse make this case notable.

Predictive value of blood culture in acute bacterial meningitis

To evaluate predictive value of blood culture as an effective alternative laboratory tool for isolation of causative organism in acute pyogenic meningitis. It is a hospital based prospective longitudinal hospital based study performed from May 2007 to May 2009. A total number of 310 children of age group 2 months-14 years who presented to the hospital with probability of bacterial meningitis were screened in the study. Eighty cases excluded by preset exclusion criteria and rest 230 formed the analytic sample. Pretreatment blood culture with concomitant lumbar puncture or lumbar puncture within 2 h of antibiotic administration for cerebrospinal fluid analysis was obtained. The main outcome parameter was the predictive value of blood culture for isolation of causative organism in acute bacterial meningitis. Blood culture revealed a sensitivity of 73.28% (95% confidence interval [CI]: 64.85%–80.63%), specificity of 87.88% (95% CI: 79.78%–93.58%), positive predictive value of 88.9% (95% CI: 81.40%–94.13%), negative predictive value of 71.31% (62.42%–79.14%), positive likelihood ratio of 5.97 and negative likelihood ratio of 0.30. Probability of isolation of causative organism by blood culture in bacterial meningitis was found to be highest among infants (82%) and least in children aged above 5 years (54.17%). When compared to gold standard cerebrospinal fluid diagnostic criteria, blood culture has a high sensitivity, specificity, positive predictive value and likelihood ratio to be an effective alternative laboratory tool for isolation of causative organism in acute bacterial meningitis especially in infants and younger children.

Constrictive Pericarditis A Rare Complication With Primary Varicella Infection

Primary varicella zoster virus (VZV) infection is a highly contagious and very common infection among the pediatric population. Complications are generally mild. Rarely, it can produce serious life-threatening cardiovascular complications such as myocarditis, pericarditis, and pericardial effusion. We report a case of massive pericardial effusion leading to the development of constrictive pericarditis after 5 weeks of VZV infection in an 8-year-old boy. It endangered his life and was managed efficiently by a multimodal therapeutic approach.