Mridula Chatterjee

Efficacy of Lactobacillus rhamnosus GG in acute watery diarrhoea of Indian children: A randomised controlled trial

Aim:  To evaluate the role of Lactobacillus rhamnosus GG (LGG) as probiotic in acute watery diarrhoea (AWD).

Effect of Lactobacillus rhamnosus GG in persistent diarrhea in Indian children: a randomized controlled trial.

Aim To evaluate the role of Lactobacillus rhamnosus GG (LGG) as probiotic in persistent diarrhea (PD) in children of North Bengal, India. Setting Hospital-based study. Design Randomized, double-blind controlled trial. Patients and Methods All patients of PD admitted over a period of 2 years were included in the study as per predefined inclusion criteria. They were randomized to receive oral rehydration solution (ORS) alone, or ORS plus LGG powder containing 60 million cells, twice daily for a minimum period of 7 days or till diarrhea has stopped along with correction of dehydration with ORS and/or intravenous fluids as per WHO protocol and antibiotics in culture positive patients. The duration and frequency of purge and vomiting were studied. Data were analyzed by SPSS-10 software. Statistical significance was calculated by Student t test and χ2 test. Results The study comprised of 235 patients randomized into 2 groups, cases (117) and controls (118). Both the groups were similar with respect to age, number of breastfed infants, presentation with dehydration, degree of protein energy malnutrition, and distribution of infections. Stool culture was positive in 90 (38.3%) patients, Escherichia coli being the commonest organism followed by Shigella spp. and Clostridium difficile. The mean duration of diarrhea was significantly lower in the cases than in controls (5.3 vs. 9.2 d). The average duration of hospital stay was also significantly lesser in cases. No complication was observed from the dose of LGG used. Conclusions LGG (dose of 60 million cells) could decrease the frequency and duration of diarrhea and vomiting and reduced hospital stay in patients of PD.

Increased interleukin-4 and decreased interferon-γ levels in serum of children with asthma.

BACKGROUND AND PURPOSE Immune and inflammatory responses, mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with over expression of T helper (Th)-2 cytokine, particularly interleukin (IL)-4 and IL-5, and decreased expression of Th-1 cytokine, IL-2 and IFN-γ. We hypothesized that there would be an imbalance in the levels of circulating IL-4 and IFN-γ in the asthmatic subjects. METHOD We investigated serum levels of IL-4 and IFN-γ among eighty children (18 steroid-naïve, 30 steroid-treated children with asthma and 32 healthy controls) using commercially available ELISA kits. RESULTS Serum level of IL-4 was significantly higher in steroid-naïve group of asthmatic children compared to the healthy control subjects and was lower in steroid-treated group though the level was statistically not significant. In contrast, serum levels of IFN-γ were significantly lower in both steroid-naïve and steroid-treated groups of asthmatic children compared to healthy control subjects. CONCLUSION The results of our study suggest that serum level of IL-4 may be elevated in concert with decreased level of IFN-γ in asthma. Determination of serum levels of IL-4 and IFN-γ may be a useful tool for understanding the disease processes in asthma.

A study of the association of childhood asthma with HLA alleles in the population of Siliguri, West Bengal, India

Asthma is a heterogeneous disease for which a strong genetic basis is firmly established. It is a complex disorder influenced by gene-environment interaction. Human leukocyte antigen (HLA) genes have been shown to be consistently associated with asthma and its related phenotypes in various populations. The aim of this study was to determine the frequency of the selected HLA classes I and II allelic groups in asthmatic and control groups. HLA typing was performed using polymerase chain reaction-sequence-specific typing (PCR-SSP) method. The allele frequency was estimated by direct counting. Frequency of each HLA allelic group was compared between asthmatic group and control group using χ(2) test. P-value was corrected by multiplying with the number of the allelic groups studied. Odds ratio (OR) and its corresponding 95% confidence interval (CI) for each allelic group were calculated using graphpad instat 3.10. The results of this study showed a significantly higher frequency of HLA-DRB1*03 in asthmatics than in controls (11.43% vs 3.64%, OR = 3.78, 95% CI = 1.61-8.85, P = 0.0025, Pcorr  < 0.05). Analysis of HLA alleles in low and high total serum immunoglobulin E (IgE) level in asthmatics revealed no significant association. HLA-DRB1*03 may be implicated in the susceptibility to asthma in the pediatric population.

Encephalitis Following Wasp Sting

Sir, Hymenoptera stings are encountered worldwide; single sting may result in anaphylaxis. Multiple stings cause shock, renal failure, intravascular hemolysis or rhabdomyolysis. Exceptionally, serum sickness, vasculitis, neuritis, encephalitis are also reported. Neurological complications manifest days to weeks after stings. The authors report a girl who developed allergic encephalitis days after being stung by multiple wasps. A 3-yr-old previously healthy girl presented with head ache, vomiting, seizure and drowsiness. History of multiple wasp stings with local reaction was elicited. She was stable by symptomatic management but started having neurological symptoms on day 4. Examination showed; GCS (9/13), spasticity in four limbs, brisk reflexes and bilateral extensor planter. Meningial signs of cranial nerve palsies were absent. Investigations detected; normal hemoglobin and platelets with marked neutrophilic leukocytosis. CSF analysis showed 10 mononuclear cells, protein was 120 mg/dl; sugar was 50 mg/dl (blood sugar of 94 mg/dl). CSF and serum for Japanese encephalitis virus and dengue antibody were negative. Renal function tests, liver function tests, urinalysis and electrocardiography were normal. Hymenoptera induced delayed allergic encephalitis was diagnosed. Intravenous methylprednisolone was administered (30 mg/kg/day, for 5 days) along with symptomatic management. She regained consciousness but motor impairment persisted. Physiotherapy was initiated in continuation to anticonvulsant medication. Follow up revealed further improvement. Hymenoptera induces, acute IgE mediated type I hypersensitivity. Type III reaction with deposition of immune complexes and activation of complement system occur days to weeks after sting. Neurological involvements are uncommon; onset varies from 30 s to 96 h. Reported complications are peripheral or facial neuropathies, myelitis, encephalitis, encephaloradiculoneuritis, optic neuropathy [1] myasthenia gravis, cerebral infarction, acute inflammatory polyradiculopathy, brachial neuropathy, trigeminal neuritis and generalized polyneuropathy [2]. The cerebral lesions consist of edema, hemorrhage, infarction, necrosis and degeneration. Mechanisms include vasoconstriction, platelet aggregation and retrograde stimulation of superior cervical ganglion causing occlusion of terminal internal carotid artery. Means et al. reported a case of bilateral limbs weakness and numbness; following a yellow jacket sting. Necropsy revealed areas of demyelination throughout central and peripheral nervous system with necrosis and inflammatory infiltration in the brain stem and spinal cord [3]. P Likittanasombut et al. reported severe encephalomyeloradiculoneuritis. [4] Pathogenesis of M. Roy :M. Chatterjee Pediatric Medicine, North Bengal Medical College & Hospital, Darjeeling, West Bengal, India

Intravenous Colistimethate Sodium in Neonatal Sepsis

To the Editor: Colistin is a re-emerging antibiotic in the last few years owing to increase in Gram negative multi drug resistant (MDR) nosocomial infections. Effect of the drug on the immature renal system of neonates has not been studied extensively yet. In this retrospective descriptive study, we have tried to evaluate the safety and efficacy of colistimethate sodium (CMS) in MDR neonatal infections. Medical records of all the neonates treated with intravenous CMS for MDR sepsis in neonatal care units between September 2013 and February 2015 were retrieved and analyzed. Twenty eight neonates with mean gestational age of 35.57 wk (range 28–43 wk), and mean birth weight of 2048 g (range 990–3780 g) received CMS during the study period. Mean postnatal age at initiation of CMS therapy was 8.46 d (range 5–12 d), and mean duration of CMS therapy was 16.1 d (range 14–24 d) in surviving cases. CMS was used in the doses of 50,000–75,000 IU/ kg/d. Empirical antimicrobials were continued despite known resistance to them owing to lack of data on efficacy of colistin. Following CMS therapy, 22 neonates (78.6 %) survived. Death in the remaining 6 neonates (21.4 %) was unrelated to adverse effects of CMS. There were no significant statistical differences between baseline and post CMS values of blood urea, serum creatinine, and estimated creatinine clearance (Table 1). Nephrotoxicity was noted in 3 neonates (10.7 %) on 4– 6 d of therapy. However, those neonates were on netilmicin therapy in addition to CMS; and renal functions returned to normal after discontinuation of netilmicin. Moreover, urine examination of the study population revealed no significant abnormality. In some related studies, the efficacy of CMS was 72.2 % to 81 % and nephrotoxicity was noted among 5.1 % to 19 % neonates [1–3]. CMS was used in dose of 50,000–1,20,000 IU/kg/d or 2–5 mg/kg/d in their study subjects. Although electrolyte imbalance was observed in some studies [2, 4], we did not find such changes in our cohort.