Krishna Vilhekar

Congenital malformations at birth in Central India: A rural medical college hospital based data.

OBJECTIVE: To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra. MATERIALS AND METHODS: All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable. RESULTS: Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies. CONCLUSION: Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers’ babies is the important factor to be considered.

Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India.

Objectives: To study the blood pressure of school going children in a rural area and its relationship with the anthropometric indices. Methods: A prospective, cross-sectional study was carried out from November 2006 to December 2007 in the school going children between the ages of 6–17 years from eight different schools in the rural areas of Wardha district. The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in both sexes followed by complete clinical examination with special emphasis on cardiovascular system. Hypertension (HT) was defined as SBP or DBP exceeding the 95th percentile for age, gender, and height on at least three separate occasions, 1–3 weeks apart. SPSS software was used to analyze the data. Coefficient correlation tests were employed to assess the relation between BP and anthropometric variables. Results: Of 2643 school children, 1227 were boys and 1416 girls with a male to female ratio of 1:1.16. In boys, SBP and DBP increased with age except a marginal decline in SBP at the age of 17 years (−0.09) and decrease in the DBP (−1.29) at 16 years of age. In girls, SBP and DBP also increased with age except at 11 years, wherein there was a mild decrease in SBP (−0.09) as well as the DBP (−0.24). Correlation coefficient analysis showed highly significant positive correlation of height with SBP and DBP. There was a significant correlation of SBP and DBP with the weight, and body mass index (BMI). The prevalence of HT was 5.75% (i.e., 3.25% for systolic HT and 2.49% for diastolic HT). Conclusion: We recommend that there is a need for checking BP to detect HT in children, so that remedial measures can be initiated as early as possible.

Perforated acute appendicitis in a term neonate.

Acute appendicitis is rare in term neonates. In most of the reported cases, it is seen as a complication of necrotizing enterocolitis, Hirschsprung’s disease, cystic fibrosis, meconium plug, inguinal hernia, umbilical hernia, Group B Streptococcal septicemia and chorioamnionitis. A surviving term male newborn with isolated acute appendicitis with perforation is reported. A high index of suspicion of acute appendicitis, early surgery and the importance of a thorough search for a perforation in cases of neonatal acute abdominal distention is stressed. Literature of this rare condition is reviewed briefly

Pain response of neonates to venipuncture

Objective: To study the physiological and behavioral response to pain.Methods: 80 healthy neonates requiring bilirubin estimation, blood sugar etc. were randomly assigned to receive a venous puncture. All parameters were recorded 10 minutes prior, during and 10 minutes after the procedure. Evaluated NIPS score and RR., HR, NIBP and 02 saturation observed on Datex-Ohmeda multimonitor.Results : After the venepuncture, heart rate (p<0.001 ) and blood pressure (p<0.001 ) were significantly increased in both the groups but more significant increase was present in Group l(>2.5kg) as compared to Group II (>2.5kg). Respiratory rate was also increased but more significant in Group II(p<0.001) whereas Oxygen saturation was decreased in both the groups but more significant in Group I (p<0.001). Median Neonatal Infant Pain Scale (NIPS) score was higher in both the Groups (p<0.001 ).Conclusion : The outcome measures appear to be reliable indices of term neonates responses to painful stimulation. NIPS are suitable instruments for neonatal pain evaluation.

Primary pyomyositis in a child

Pyomyositis is a term used to denote primary pyogenic infection of the skeletal muscle. Striped muscle tissue is normally resistant to bacterial infection; pyomyositis is very rare. Primary pyomyositis is a purulent infection of striated muscle that is thought to be caused by seeding from a transient bacteremia. Pyomyositis should be considered in the differential diagnosis of septic-appearing children as well as children complaining of joint pain or muscle aches. The diagnosis can be aided by either a computed tomography or magnetic resonance imaging scan. If the patient does not respond quickly to antibiotics and surgical intervention, there is either a recurrence of the previously debrided abscess or an unrecognized secondary abscess. Here, we present a case of primary pyomyositis of the iliacus muscle that might be due to severe pneumonia in a five-year-old child.

Peak expiratory flow rate of rural school children from Wardha district, Maharashtra in India

BackgroundPeak expiratory flow rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children. The PEFR can be measured by a simple instrument—peak expiratory flow meter. The aim of this study was to determine the normal PEFR in rural school children from Wardha district of Maharashtra state, India.MethodsThe PEFR was measured in 1078 healthy rural school children, living in Wardha district, Maharashtra using the Mini-Wright peak flow meter. All measurements were obtained in a standing position and the best out of three trials was recorded. Anthropometric measurements, weight, height, and mid-upper-arm circumference (MAC) were recorded, and body surface area (BSA) and body mass index (BMI) were calculated.ResultsPositive correlation was seen between age, height, weight and PEFR. The regression equations for PEFR were determined for boys and girls separately. The boys had higher values than the girls at all heights. The prediction equation for PEFR based on height was PEFR = 3.64 height (cm) − 257.86 (R=0.47, R2=0.22) for female; PEFR = 4.7 height (cm) − 346.51 (R=0.62, R2=0.38) for male.ConclusionPEFR is a reliable measurement, which can be used routinely and regularly in rural areas for assessment of airway obstruction and prediction formula derived for use in this population.

Acute acalculous cholecystitis in a child with Plasmodium falciparum malaria.

Abstract We report a 7-year-old girl who presented with features of acute acalculous cholecystitis. She was found to be positive for Plasmodium falciparum. To the best of our knowledge, this is the first report of acalculous cholecystitis caused by P. falciparum in a child.

Reliability of perception of fever by touch.

Objective : To assess the reliability of touch to predict fever in children.Methods : 200 children who reported with fever formed the study material. Group I consisted of 100 children between 0–1 year of age and Group II consisted of 100 children between 6–12 years of age. Preterm, neonates under warming device, tachypnoeic and hypothermic were excluded from the study. The caregiver (CG) and the medical staffs (MS) response regarding presence or absence of fever by touch was noted in each child. Both were blinded to each other’s response. Immediately temperature was recorded by calibrated rectal thermometer in Group I and calibrated axillary thermometer in Group IIResults : The CG’s touch had a sensitivity of 70.5% specificity of 40.9%, PPV of 38% NPV of 72.9%, PLR was 1.16 and NLR was 0.75. The MS’s touch had a sensitivity of 78.0%, specificity of 63.6%, PPV of 38.0% NPV 84.8%, PLR of 2.08 and NLR of 0.36. There is over and under diagnosis of fever by both, the former being more by the CG reflecting the parental anxiety. The MS’s touch is better to affirm or negative fever as compared to CG. The best site to palpate for presence of fever was abdomen, neck and forehead.Conclusion : Touch is not a valid screening test for fever. It is recommended that a thermometer must always be used by the MS to record fever and CG must be motivated for the same.

Group B Streptococcal Meningitis in a 5-year-old Boy

Group B Streptococcus (Streptococcus agalactiae) is a well-known cause of early and late onset infections in neonates and very young infants. Recently attention has focused on the changing spectrum of invasive Group B Streptococcus (GBS) disease, including children beyond early infancy and non-pregnant adults. There is very little information available on invasive GBS infection especially meningitis in pediatric population older than three months of age. We report a case of uncomplicated meningitis due to GBS in a previously healthy 5-year-old boy. The literature on infection especially meningitis caused by Group B Streptococcus beyond infancy is reviewed.

Unilateral pulmonary agenesis and renal anomalies associated with in situ neuroblastoma of the adrenal gland.

An association of unilateral pulmonary agenesis within situ neuroblastoma of adrenal gland in a newborn having multiple congenital anomalies is being reported. Polycystic right kidney and absent left kidney, leading to severe oligohydramnios with secondary Potter’s syndrome and Breech deformation sequence, were additional malformations present in our proposita