Dipti Agarwal

Role of Multivitamins, Micronutrients and Probiotics Supplementation in Management of HIV Infected Children

ObjectivesTo assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy.MethodsThis was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enroled children were randomized to receive micronutrients for 6xa0mo or probiotics for 3xa0mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6xa0mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients.ResultsIn micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (pu2009=u20090.049) when compared to controls after 6xa0mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (pu2009=u20090.0022) in children >5xa0y. Control group showed significant decline in CD4 count in children ≤5 y (−65.3 cells/mm3, p=0.005) and in children >5xa0y (−87.9 cells/mm3, p=0.05) after 12xa0wk of supplementation.ConclusionsProbiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.

Fever in Children and Fever of Unknown Origin

Fever is the most common symptom in children and can be classified as fever with or without focus. Fever without focus can be less than 7xa0d and is subclassified as fever without localizing signs and fever of unknown origin (FUO). FUO is defined as a temperature greater than 38.3xa0°C, for more than 3xa0wk or failure to reach a diagnosis after 1xa0wk of inpatient investigations. The most common causes of FUO in children are infections, connective tissue disorders and neoplasms. Infectious diseases most commonly implicated in children with FUO are salmonellosis, tuberculosis, malaria and rickettsial diseases. Juvenile rheumatic arthritis is the connective tissue disease frequently associated with FUO. Malignancy is the third largest group responsible for FUO in children. Diagnostic approach of FUO includes detailed history and examination supported with investigations. Age, history of contact, exposure to wild animals and medications should be noted. Examination should include, apart from general appearance, presence of sweating, rashes, tonsillitis, sinusitis and lymph node enlargement. Other signs such as abdominal tenderness and hepatosplenomegly should be looked for. The muscles and bones should be carefully examined for connective tissue disorders. Complete blood count, blood smear examination and level of acute phase reactants should be part of initial investigations. Radiological imaging is useful aid in diagnosing FUO. Trials of antimicrobial agents should not be given as they can obscure the diagnosis of the disease in FUO.

Epidemiological Profile of Acute Viral Encephalitis

ObjectiveTo study the etiology and clinico-epidemiological profile of acute viral encephalitis in children with acute encephalitis syndrome (AES).MethodsAn observational study including 100 patients fulfilling the criteria for AES was conducted in children of age group 1xa0mo – 16xa0y. Viral isolation was done on RD cells, HEp-2 cells and Vero cells from the cerebrospinal fluid samples of suspected viral encephalitis (VE) cases. An enzyme immunoassay for IgM antibodies was performed for measles, mumps, Varicella zoster virus (VZV), Herpes simplex virus 1 (HSV1) and Japanese encephalitis virus (JEV). Multiplex polymerase chain reaction (PCR) was done for Cytomegalovirus, Epstein Barr virus (EBV), HSV1 & 2, VZV, Enterovirus, Parecho virus, Human Herpes virus (HHV 6, 7) and Parvovirus B19. A micro neutralization test was performed for Enterovirus 71.ResultsOut of enrolled 100 patients, 73 were of probable viral encephalitis. HSV1 (31.50%) was the commonest virus followed by Adenovirus (10.95%), Parvovirus (2.73%), JE virus (1.36%), Enterovirus (1.36%), EBV (1.36%), and mixed infection with HSV & EBV (1.36%). HSV 1 caused significant morbidity in children. The common computed tomography (CT) findings were hypodensities in the fronto- parietal lobe followed by cerebral edema.ConclusionsThe landscape of AES in India has changed in the previous decade, and both outbreak investigations and surveillance studies have increasingly reported non-JEV etiologies; because of these findings there is a need to explore additional strategies to prevent AES beyond vector control and JEV vaccination.

PCR targeting IS6110 in diagnosing tuberculosis in children in comparison to MGIT culture

BACKGROUNDnDiagnosis of tuberculosis (TB) in children is difficult in children especially in extrapulmonary tuberculosis (EPTB). This study was conducted to evaluate the use of polymerase chain reaction (PCR) targeting IS6110 in the diagnosis of TB in children with pulmonary TB and EPTB and also to compare its performance with MGIT 960 culture and conventional microscopy.nnnMETHODSnA total of 142 cases (50 pulmonary, 92 extrapulmonary) of suspected TB patients <15 years of age were included in the study. The clinical specimens obtained from these cases were subjected to Ziehl-Neelsen staining (ZN), MGIT 960 TB culture and PCR targeting insertion sequence IS6110. Sensitivity and specificity of PCR were calculated in pulmonary and extrapulmonary specimens. The results were compared to MGIT culture.nnnRESULTSnPCR targeting IS6110 sequence had sensitivity of 69.01% in various clinical specimens which was significantly more than MGIT culture showing a sensitivity of 47.41% (p<0.05). Sensitivity of PCR IS6110 in extrapulmonary specimens was 65.21% which was lower than sensitivity in pulmonary specimens (76%) but was not statistically significant (p>0.05).nnnCONCLUSIONSnDiagnostic efficacy of PCR IS6110 in pulmonary and extrapulmonary TB cases was similar. PCR using IS6110 primer had significantly better efficiency than MGIT culture in diagnosing TB in children.

GeneXpert for Diagnosis of Tubercular Meningitis

Diagnosis of tubercular meningitis (TBM) is difficult in children. The GeneXpert MTB/RIF assay has been recommended by WHO in 2013 to be used in children and in extra pulmonary clinical specimens. The present study was designed to assess the diagnostic utility of GeneXpert in detecting Mycobacterium tuberculosis in cerebrospinal fluid (CSF) in TBM cases and to compare the results with liquid culture BACTEC 460. Thirty four subjects <15xa0y were diagnosed as TBM based on clinical, CSF and imaging details. Sensitivity of GeneXpert in CSF was 38.24xa0% as compared to Bactec culture which was only 14.71xa0% (p 0.0279). To conclude, GeneXpert MTB/RIF test is able to rapidly confirm diagnosis of TBM with higher sensitivity as compared to conventional methods and liquid culture.

Site Feasibility Environmental Impact Assessment for the Establishment of a Coal-Based Thermal Power Plant At Dewas In Madhya Pradesh

The study was conducted to find out the environmental impacts of establishing a 260 r MW coal based thermal power plant (TPP) at Dewas in Madhya Pradesh, India through monitoring of existing environmental parameters such as ambient air quality, water quality, land environment, noise environment, biological environment, socio-economic environment, etc. Environmental Impact Assessment (EIA) study has been carried out which reveals that in general the site conditions are suitable for establishment of proposed TPP in the region as it will have net positive environmental impacts if proper control measures are adopted.