Krishnan Rajeshwari

Use of VSL#3 in the Treatment of Rotavirus Diarrhea in Children : Preliminary Results

We conducted a double-blind randomized placebo-controlled study to evaluate efficacy and tolerability of VSL♯3 (CD Pharma India) in the treatment of acute rotavirus diarrhea in children. The patients were randomly assigned to receive 4 days of oral treatment with VSL♯3 probiotic mixture or placebo in addition to usual care for diarrhea. Results: Out of 230 rotavirus-positive acute diarrhea children, 224 children completed the study, (113 in the drug group and 111 in the placebo group). At recruitment on Day 1, there were no significant differences between the 2 groups in terms of frequency of vomiting, mean loose stool frequency, stool consistency, and mean frequency of oral rehydration salts (ORS) and intravenous fluids administered. On Day 2, a lower mean stool frequency and improved stool consistency was noted in the drug group, which achieved statistical significance. This was also reflected in the lower volume of ORS administration in the drug group. Even on Day 3, mean loose stool frequency and frequency of ORS use and frequency of intravenous fluid use was significantly lower in the drug group. The differences in the frequency of loose stools persisted till 8 hours of Day 4. After this, as the placebo group also showed spontaneous improvement the difference between the 2 groups in terms of the overall stools frequency became comparable. However, the overall ORS requirement continued to be significantly lower in the drug group even on Day 4. The overall recovery rates were significantly better in the drug group compared with placebo. No side effects were noted with the use of the probiotic mixture. Use of probiotic mixture VSL♯3 in acute rotavirus diarrhea resulted in earlier recovery and reduced frequency of ORS administration reflecting decreased stool volume losses during diarrhea.

The clinical spectrum of chronic liver disease in children presenting to a tertiary level teaching hospital in New Delhi

SUMMARY We report on the clinical spectrum of chronic liver disease (CLD) in children presenting to a tertiary level teaching hospital. Children aged <14 years with suspected CLD presenting to the paediatric gastroenterology department of Maulana Azad Medical College between January 1999 and December 2004, were prospectively studied. They were all given liver function tests, abdominal ultrasonography, endoscopy, viral markers and were checked for Wilsons disease, autoimmune hepatitis and liver biopsy wherever feasible. Other tests for metabolic liver diseases were done when indicated. CLD was diagnosed in 174 children over the six-year period. Cryptogenic cirrhosis was the most common entity, followed by hepatitis B-induced liver disease and Wilsons disease. Most patients presented late with evident portal hypertension.

Case report: Isolated unilateral pulmonary vein atresia diagnosed on 128-slice multidetector CT

Unilateral pulmonary venous atresia is an uncommon entity that is generally believed to be congenital. Most patients present in infancy or childhood with recurrent chest infections or hemoptysis. Pulmonary angiography is usually used for definitive diagnosis. However, the current multislice CT scanners may obviate the need for pulmonary angiography. We report two cases diagnosed using 128-slice CT angiography. On the CT angiography images both these cases demonstrated absent pulmonary veins on the affected side, with a small pulmonary artery and prominent bronchial or other systemic arterial supply.

Diarrhoeal outbreak of Vibrio cholerae 01 Inaba in Delhi.

SUMMARY V. cholerae O1 Eltor serotype Ogawa has been causing most of the cholera outbreaks in India till recently. However this communication reports the occurrence of Vibrio Cholerae O1 Inaba in Delhi in 2005, as a predominant causative organism of cholera in children. All strains isolated were sensitive to gentamicin and a high level of resistance towards nalidixic acid and amoxicillin was seen. There was no case fatality.

Portal vein thrombosis resulting from tubercular lymphadenitis: An unusual scenario

2013 Arab Journal of Gastroenterology. Published by Elsevier B.V. All rights reserved. Abdominal tuberculosis is commonly encountered in our side of the world. It is seen to involve the peritoneum, bowel, lymph nodes and solid organs. However, thrombosis of the portal vein and cavernoma formation is only rarely encountered despite the large number of cases of abdominal tuberculosis in our clinical practice. We report one such case in a 2-year-old child, who presented with low grade fever, weight loss and progressive abdominal swelling for 3 months. On examination, there was severe wasting. Abdomen was distended with hepatosplenomegaly. Bipedal edema was present. There was no peripheral lymphadenopathy. Laboratory findings revealed hemoglobin of 4.6 gm/dl, total leukocyte count of 5200 cells/mm3, differential leukocyte count of neutrophils 55, lymphocytes 40, eosinophils 3 and monocytes 2. ESR was markedly raised to 500 mm in 1st hour. However, Mantoux examination was nonreactive. This was likely due to severe malnutrition which resulted in a false negative mantoux result. CT (Fig. 1a and b) revealed multiple conglomerate necrotic hypodense lymph nodes involving the mesentery, retroperitoneum and periportal region. The portal vein was replaced by a cavernoma suggestive of portal vein thrombosis. In view of these imaging findings, the patient was put on four drug antitubercular therapy (ATT), comprising of isoniazid, rifampin, pyrazinamide and ethambutol. Edema subsided within 4 weeks and fever abated within 3 weeks of drug initiation. After one year of ATT, there was considerable clinical improvement with significant weight gain. A repeat CT performed at this time depicted marked regression of the nodes but portal cavernoma persisted (Fig. 2a and b). f Gastroenterology. Published by El akshi garden, Near Subhash 91 9968604361; fax: +91 11 r). In cases of abdominal tuberculosis, lymph nodes are encountered in up to two-thirds of patients [1], portal and peripancreatic nodes being the most common. Periportal lymphadenopathy may result in the compression of the portal vein leading to portal vein thrombosis and portal hypertension. Obstructive jaundice may also result from compression of the bile duct. However in practice, it has been reported only rarely. In 1845, Knight reported the first case of portal hypertension and obstructive jaundice due to compression of the portal vein and common hepatic duct by tuberculous lymph nodes [2]. In a retrospective review of 183 cases of abdominal tuberculosis from 2002 to 2010, thrombosis of the splenoportal axis associated with abdominal lymphadenopathy was found in only seven patients whereas abdominal lymph nodes were encountered in 127 patients [3]. They found that the occurrence of portal vein thrombosis was independent of the size of the nodes. It has been postulated that contiguous spread of inflammation with perivascular cuffing, granulomas in the vessel wall with subintimal fibrosis and intraluminal thrombi may be the other factors that contribute to portal thrombosis [3,4]. Our case showed no reversal of portal vein thrombosis despite clinical improvement and marked regression of abdominal nodes. This is consistent with the findings in the literature where all cases were irreversible barring one case, where only compression of the portal vein by periportal lymph nodes was seen [3,5]. In conclusion, although periportal lymph nodes with portal vein thrombosis is a rare finding in patients with abdominal tuberculous, the entity should be kept in mind to prevent us from misdiagnosing these cases as malignancy. These patients usually recover on antituberculous therapy with portal hypertension as the only sequel [6]. sevier B.V. All rights reserved. Fig. 2. Contrast enhanced axial CT (A) and coronal reformatted images (B) in the same patient after one year of antitubercular therapy depict persistence of the portal cavernoma (arrow in A) in association with caudate lobe hypertrophy (star). There is marked resolution of the abdominal lymph nodes (block arrow in B). Fig. 1. Contrast enhanced axial CT (A) and coronal reformatted images (B) in a 2-year-old child with tuberculosis show thrombosis of the portosplenic axis with multiple collateral formation at porta and at splenic hilum (arrows in A). Multiple hypodense lymph nodes are seen in the mesentery and involving the periportal and perisplenic locations (block arrows in B). 86 J. Kumar et al. / Arab Journal of Gastroenterology 14 (2013) 85–86 Conflicts of interest The authors declared that there was no conflict of interest.

Asymptomatic multiple intracardiac tuberculomas in a child

Tuberculosis is widely prevalent among children in India, especially in those with coexisting severe malnutrition and immunodeficiency. Uncommon sites for tuberculosis are frequently seen. However, intracardiac tuberculomas are extremely rare in children. To the best of our knowledge, this is the first case report of multiple asymptomatic intracardiac tuberculomas in a child. Most intracardiac tuberculomas cause symptoms, especially in adults. In asymptomatic children non surgical management of intracardiac tuberculomas appears to be a safe treatment option as complete resolution occurs with antituberculous therapy.

Dengue fever in infants: report of three cases.

Dengue fever has classically been described as a disease of children and young adults. Infants are naturally protected by virtue of maternally derived immunoglobulins, especially in endemic countries. The resurgence of dengue, coupled with the availability of early and sensitive diagnostic methods and a high degree of clinical suspicion, has led to an increasing number of infants being diagnosed. There is a wide spectrum of clinical manifestations, particularly in infancy. Here we describe three cases presenting with diverse clinical features, their subsequent management and outcome.

Draft Genome of Escherichia coli O146 Isolate from Maulana Azad Medical College, New Delhi, India

ABSTRACT Here, we report the draft genome sequence of enteropathogenic Escherichia coli (EPEC) O146 strain isolated from a 1-year-old child with acute diarrhea in Delhi who recovered completely. The multidrug transporter (mdtABCD) gene, responsible for drug resistance, is present. The strain also contains the astA gene, an additional virulence determinant.