D. K. Singh

Sero-prevalence of Viral Co-infections in HIV Infected Children of Northern India

ObjectiveTo assess the prevalence of viral co-infections in HIV infected children.MethodsChildren born to HIV seropositive parents and those children who were suspected to be HIV infected based on clinical presentation by the pediatrician were screened for HIV −1 and 2 antibodies as per National Aids Control Organization (NACO) guidelines. Those found to be seropositive for HIV infection were further tested for Hepatitis B&C, Herpes simplex virus and Human cytomegalovirus infection.ResultsAmong 803 children screened, 101 were found positive for HIVantibodies. Among the five viral markers tested, HCMV IgG was positive in 88 children (87.1%). HCMV IgM was positive in 35 cases (34.6%). HBsAg tested positive in 30 children, while anti-HCV IgM was reactive in 27 cases. IgM anti- HSV antibodies were observed positive in 59 (58.4%) cases. Both hepatitis virus coinfection (HBsAg and anti- HCV IgM antibodies) was observed in 10 HIV positive children, while both Herpesviridae family viruses (HCMV -IgM antibodies and HSV -IgM antibodies) were positive in 30 cases (29.7%).ConclusionViral co-infections are significantly higher in HIV positive children, which adds to significant mortality and morbidity and should therefore be screened in all HIV positive children for timely treatment in order to improve the quality of life and better survival of HIV infected children.

Effect of Domperidone in 2nd week Postpartum on Milk Output in Mothers of Preterm Infants

To the Editor: Various non pharmacologic modalities like counseling and galactagogues have been tried to establish optimum lactation in mothers experiencing inadequate milk output [1, 2]. We evaluated the effect of early use of domperidone (7–14 d postpartum) on the milk output in mothers of preterm infants. This was a randomized controlled trial done in the Neonatal Intensive Care Unit of a tertiary care hospital. The study population included 32 mothers of preterm sick neonates (7–14 d) having insufficient milk output who were randomized into receiving domperidone or placebo. Serum prolactin levels were estimated on day 1 and on day 8 of the study. The mothers in the domperidone group showed a significant increase in the milk output after 7 d compared to those in the placebo group. The median [inter quartile range (IQR)] of the milk increment in the domperidone group was 186.0 [126.5–240] ml/d compared to 70 [49.5–97] ml/d in the placebo group (p 0.004). The difference in prolactin levels between D1 and D8 in the domperidone group and the placebo group were, median (IQR) 18.7 (−39.5 to 55.6) μ/L and 11.9 (−8.3 to 37.5) μ/L respectively with p value of 0.88. There was no significant difference in the weight gain of infants between the two groups. None of the mothers on domperidone reported any side effects with the drug. Wan et al. and da Silva et al. showed an increase in milk production in mothers of preterm infants receiving domperidone [3, 4]. According to Cochrane Database Systematic Review 2012, modest improvement in short term expressed breast milk volumes was seen with the use of domperidone, used at ≥14 d of postpartum days. We did not find a significant increase in the levels of prolactin after 7 d of domperidone as seen in some studies [3, 4]. Mediators and mechanism other than prolactin may be involved in the increase in milk output. The baseline prolactin levels in the mothers in our study were much higher (99.02 μg/L) than that found in previous studies which could be a reason that the prolactin levels did not show a significant increase. Although domperidone has been found to be largely safe, Paul et al. concluded that long QT syndrome secondary to domperidone in women is a cause of worry [5]. Domperidone should not be considered as a magic remedy and constant counseling and education must be considered before trial of galactogogues is given. But it can be considered in cases where all other modalities have failed, keeping in mind adequate steps for its safe and effective use.

An experience of facility-based management of severe acute malnutrition in children aged between 6–59 months adopting the World Health Organization recommendations

ObjectiveTo study the output indicators of a nutritional rehabilitation center to assess its performance.MethodsData of 182 children aged between 6–59 months with severe acute malnutrition in a nutritional rehabilitation center were analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to World Health Organization recommendations.ResultsThe recovery rate, death rate, defaulter rate, mean (SD) weight gain and mean (SD) duration of stay in the nutritional rehabilitation center were 68%, 2.2%, 4.4%, 13.0 (9.0) g/kg/d, 12.7 (6.8) days, respectively.ConclusionNutritional rehabilitation centers are effective in management of severe malnutrition.

Recurrent meningitis secondary to isolated C3 deficiency

A 5-year-old child presented with the second episode of meningitis when we started investigating her to find a cause for recurrent episode of meningitis. During this she suffered from a third attack after which she was diagnosed as having isolated C3 deficiency. She was put on penicillin prophylaxis and vaccinated against encapsulated bacteria, after which she is now doing well.

Double dose versus standard dose hepatitis B vaccine in HIV-infected children: A randomized controlled trial

ObjectiveTo compare the efficacy of double dose (20 μg) with standard dose (10 μg) of hepatitis B vaccine in HIV-infected children.MethodsUnvaccinated HIV-infected children were randomized to receive 3 doses of double dose (N=27) or standard dose (N=28) of recombinant Hepatitis B vaccine. Anti-HBs antibody titres were measured 3 mo after the last dose. An antibody titre ≥10 mIU/mL 12 weaks after the third dose was considered as serporotection.ResultSeroprotection was achieved by 17 (60.7%) children in standard dose group against 20 (74%) in the double dose group [RR (95%CI) 0.8 (0.17-1.7); P=0.29]. CD4 count < 500 cells/mm3 was significantly associated with lower rates of seroprotection.ConclusionDouble dose of hepatitis B vaccine does not seem to provide any advantage when compared to standard dose in HIV-infected children.

Nucleated RBC Count as Predictor of Neurological Outcome in Perinatal Asphyxia.

The immediate and short term outcomes of term newborns with perinatal asphyxia were studied in relation to the nucleated red blood cell count at admission. The mean (SD) NRBC/100WBC (white blood cells) was significantly higher in sequelae group than normal [9.8 (98.9) vs. 2.9 (43); P = 0.001].

Seroprevalence Studies on Brucellosis in Goats of Jammu Region

A study on brucellosis in goats from 10 different parts of Jammu region was conducted from 2011 to 2013. A total of 724 serum samples was collected and subjected to Rose Bengal plate test (RBPT), modified-Rose Bengal plate test (m-RBPT), standard tube agglutination test (STAT) and indirect-enzyme-linked immunosorbent assay (I-ELISA). The overall seroprevalence was 7.73 (RBPT), 8.29 (m-RBPT), 10.22 (STAT) and 12.98% (I-ELISA) based on individual test. Ffemales, goats from unorganized rearing and older goats were found most vulnerable. The sensitivity of m-RBPT and kappa value as well as specificity of RBPT were found best for the diagnosis of brucellosis in goats. Among serological tests, I-ELISA was found most sensitive and detected maximum number of positive sera samples.

Supplementary suckling technique for relactation in infants with severe acute malnutrition.

We report on use of supplementary suckling technique in 62 infants [mean (SD) age 2.5 (1.3) mo] with severe acute malnutrition admitted at our Nutritional rehabilitation Center. It was successful in 34 (55.7%) infants.

An experience with neonatal ventilation in eastern U.P.

Neonatology has really picked up as a superspeciality with most of the big hospitals and medical colleges coming up with a separate intensive care unit for the neonates. But still a lot is desirable in terms of availability of good quality equipment and trained medical and paramedical personnel. We did a retrospective observational study in the NICU of our medical college in eastern U.P. in which we collected data regarding all the babies weighing>1kg who received assisted ventilation over a period of 18 mo from October 2006 to March 2008. All the babies were ventilated with Inspirator (Erkadi Ltd) and put on synchronized pressure controlled intermittent ventilation (P-SIMV) which was time cycled, pressure limited with continuous flow or continuous positive airway pressure (CPAP). Data of 68 babies with a birth weight >1kg who were given assisted ventilation was analysed. Only 10 babies received CPAP alone. Overall survival amongst these ventilated neonates was 48.5%(33/68). Sepsis was the most common indication for giving mechanical ventilation(41%) followed by meconium aspiration syndrome(21%). Surprisingly RDS was responsible for ventilation in only 6 (9%) neonates. We were not able to give surfactant in any of these babies because of financial constraints. Survival was worst in babies weighing< 1.5 kg(40%) and those < 32 wk of gestation(36%). The survival was comparable in babies 32-36 wk and those >36 wk(52%). The survival of babies with birth weight>1.5 kg and <2.5 kg(55%) was better than those weighing>2.5 kg(47%).