Kamran Afzal

Extending initial prednisolone treatment in a randomized control trial from 3 to 6 months did not significantly influence the course of illness in children with steroid-sensitive nephrotic syndrome

While studies show that prolonged initial prednisone therapy reduces the frequency of relapses in nephrotic syndrome, they lack power and have risk of bias. In order to examine the effect of prolonged therapy on frequency of relapses, we conducted a blinded, 1:1 randomized, placebo-controlled trial in 5 academic hospitals in India on 181 patients, 1-12 years old, with a first episode of steroid-sensitive nephrotic syndrome. Following 12 weeks of standard therapy, in random order, 92 patients received tapering prednisolone while 89 received matching-placebo on alternate days for the next 12 weeks. On intention-to-treat analyses, primary outcome of number of relapses at 1 year was 1.26 in the 6-month group and 1.54 in the 3-month group (difference -0.28; 95% confidence interval (CI) -0.75, 0.19). Relative relapse rate for 6- vs. 3-month therapy, adjusted for gender, age, and time to initial remission, was 0.70 (95% CI 0.47-1.10). Similar proportions of patients had sustained remission, frequent relapses, and adverse effects due to steroids. Adjusted hazard ratios for first relapse and frequent relapses with prolonged therapy were 0.57 (95% CI, 0.36-1.07) and 1.01 (95% CI, 0.61-1.67), respectively. Thus, extending initial prednisolone treatment from 3 to 6 months does not influence the course of illness in children with nephrotic syndrome. These findings have implications for guiding the duration of therapy of nephrotic syndrome.

Age-specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh, North India.

Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age.Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. < 1, 1–4, 5–9 and 10–14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA.Results: Overall 4.35% (95%CI, 2.44 –6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1–4 year age category. In the < 1, 5–9 and 10–14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577).Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44 –6.25). The prevalence progressively increases and peaks in the 1–4 years age group. It is least in 10–14 years age group.

Safety and efficacy of isotonic (0.9%) vs. hypotonic (0.18%) saline as maintenance intravenous fluids in children: a randomized controlled trial.

ObjectiveTo compare the safety and efficacy of isotonic versus hypotonic maintenance fluid in children.DesignRandomized controlled trial.SettingTertiary-level teaching hospital.Participants60 children (age 0.5 to 12 years) who were admitted and anticipated to receive intravenous fluid for the next 48 hours.InterventionHypotonic fluid (Standard maintenance volume as 0.18% NaCl in 5% dextrose) or Isotonic fluid (60% Standard maintenance volume as 0.9% NaCl solution in 5% dextrose).Outcome measuresPrimary: Incidence of hyponatremia. Secondary: Serum sodium, serum osmolality, blood sugar, blood urea, serum creatinine, serum potassium, serum chloride, pH, urine output, change in weight, morbidity and death.ResultsAt 24 hours, hyponatremia was noted in 7 (24%) patients in the isotonic and 16 (55%) in hypotonic group (P=0.031). At 48 hours, hyponatremia was noted in 4 (14%) and 13 (45%) patients in isotonic and hypotonic group, respectively (P=0.02). There was significant change in sodium levels in both isotonic (P=0.036) and hypotonic (P<0.001) intervention groups. The peak fall in mean serum sodium level was noted at 24 hours (−6.5, 95%CI: −3.5, −9.6 mEq/L; P<0.001) in hypotonic group. In isotonic group, there was significant increase between 24 and 48 hours (4.3, 95% CI: 0.1, 8.4 mEq/L; P=0.04).ConclusionsReduced volume isotonic fluid results in fewer episodes of hyponatremia than hypotonic fluid in sick children during the first 48 hours of intravenous fluid therapy.

Stomatococcus mucilaginosus meningitis in a healthy 2-month-old child.

Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part of the normal human oral and upper respiratory tract flora. Although traditionally believed to be an organism of low virulence, Stomatococcus mucilaginosus has been reported to be an opportunistic pathogen in immunocompromised patients. We describe what we believe is the first reported case of Stomatococcus mucilaginosus meningitis in a healthy child. The isolate was multidrug-resistant, susceptible only to vancomycin. The patient was treated successfully with vancomycin after initial trials with amikacin and cefotaxime.

Epidemiology and drug resistance profile of acute bacterial meningitis in children in Northern India: a university hospital perspective

Abstract Objective To assess epidemiology, trends in etiology and the antimicrobial sensitivity pattern of the pathogens. Methods Cerebrospinal fluid was collected from 150 patients who were suspected of meningitis and processed according to standard microbiological techniques. Cerebrospinal fluid samples were tested for antigen detection by latex agglutination test (LAT). Antimicrobial sensitivity test was done by Kirby-Bauer disc diffusion method. Results Fever, abnormal movements and altered sensorium were the most common presenting features. Etiological agents were identified in 79 (53%) cases. A total of 33 (42%) samples were cultured positive while 59 (75%) were positive by LAT. Pneumococcus followed by Gram-negative organisms were the most common pathogens. Mortality was 28 (19%). The aminoglycosides had the best spectrum of antimicrobial activity. An alarming rise of methicillin-resistant Staphylococcus aureus (75%) and extended-spectrum beta-lactamase (59%) was seen. No high-level aminoglycoside resistance, AmpC or mannose-binding lectin production was observed. Conclusions Pneumococcus and Gram-negative pathogens were the most common organisms. High prevalence of drug resistant pathogens is seen. Inclusion of LAT for antigen detection in routine diagnosis adds a valuable adjunct in the rapid and accurate diagnosis of pyogenic meningitis especially in partially treated cases.