Pooja Dewan

Organochlorine pesticide residues in maternal blood, cord blood, placenta, and breastmilk and their relation to birth size

There is a growing concern that persistent organic pollutants like organochlorine pesticides (OCPs) can impair fetal growth and affect birth size. However, currently available epidemiological evidence is inconclusive. In this case-control study, we examined the association between exposure to hexachlorocyclohexane (HCH) and its isomers (α-HCH, β-HCH and γ-HCH), dichlorodiphenyltrichloroethane (DDT) and dichlorodiphenyldichloroethylene (DDE) and birth size. We recruited 60 infant-mother pairs, comprising of 30 term, small for gestational age babies with their mothers (Case group), and another 30 term, appropriate for gestational age babies with their mothers (Control group). This study was conducted in a tertiary hospital in Delhi, India, between March, 2009 and February 2010. Organochlorine pesticides were estimated in maternal blood, cord blood, placenta and breastmilk samples, using gas-liquid chromatography. Transplacental and transmammary transfer of OCPs was assessed by correlating the maternal blood OCP levels with those in cord blood and breastmilk by simple linear regression. The birthweight, crown heel length, head circumference, mid-arm circumference and ponderal index of the neonates was correlated with OCP levels in the maternal blood, cord blood, placenta and breastmilk. The OCP estimates were compared between samples of the case and control group. There was a significant (P<0.001) transplacental transfer of all OCPs, however the transmammary transfer was insignificant for most OCPs except α-HCH. The OCP levels in the case group were higher than the control group; these were significantly more for t-HCH in cord blood and breastmilk; β-HCH in maternal blood, cord blood and breastmilk; DDE in placenta and DDT in breastmilk. There was a significant negative correlation between birthweight and t-HCH levels in maternal blood (P=0.022), cord blood (P<0.001), placenta (P=0.008) and breastmilk (P=0.005); β-HCH in cord blood (P<0.001) and placenta (P=0.020); γ-HCH in placenta (P=0.045); and DDT (P=0.009). Length at birth had a significant negative correlation with t-HCH in cord blood (P=0.014) and breastmilk (P<0.001); β-HCH in cord blood (P=0.016) and breastmilk (P=0.012); DDE in placenta (P=0.016); and DDT in breastmilk (P=0.006). Similarly, OCP levels were also found to be negatively correlated with head circumference, ponderal index and chest circumference in neonates. We conclude that prenatal exposure to some OCPs could impair the anthropometric development of the fetus, reducing the birthweight, length, head circumference, chest circumference and ponderal index.

Burden of Congenital Rubella Syndrome (CRS) in India: A Systematic Review.

BackgroundRubella, though a mild, vaccine-preventable disease, can manifest with severe teratogenic effects in the fetus labeled as congenital rubella syndrome (CRS) due to primary maternal rubella infection. Despite a reduction in disease burden of several vaccine-preventable diseases through childhood immunization, CRS continues to account for preventable severe morbidity including childhood blindness, deafness, heart disease, and mental retardation.ObjectiveTo conduct a systematic review to describe the prevalence of CRS and its contribution to major long-term handicaps in Indian population. Another objective was to estimate the susceptibility to rubella infection in Indian adolescent girls and women of reproductive age-group. We also explored strategies to decrease CRS in India by identifying the immunogenicity of rubella containing vaccines (RCV) in Indian children and women, as well as their coverage in India.MethodsPublications reporting ‘CRS prevalence in general population as well as selected subgroups i.e., suspected intra-uterine infection, congenital ocular abnormalities, deafness, congenital heart disease, mental retardation, and congenital malformations’, ‘seroprevalence to rubella (IgG) amongst women and adolescents’, and ‘immunogenicity and coverage of RCVs’ in Indian population were retrieved through a systematic search. Primary databases employed were Medline through PubMed and IndMed, websites of the WHO, and UNICEF. No restrictions were applied in terms of study designs. The primary outcome measure was ‘congenital rubella syndrome’ (CRS) which was further categorized as ‘suspected CRS’ and ‘confirmed CRS’ as defined by World Health Organization (WHO).ResultsComprehensive evidence about the true burden of CRS in India is not available. Almost all studies have been done in institutional/hospital set-ups and community-based studies are grossly lacking. There are no studies assessing the prevalence of CRS in general population. All studies have evaluated the CRS burden in symptomatic cohorts of children. 1–15% of all infants suspected to have intra-uterine infection were found to have laboratory evidence of CRS. About 3–10% of suspected CRS cases are ultimately proven to have confirmed CRS with the aid of laboratory tests. CRS accounts for 10–15% of pediatric cataract. 10–50% of children with congenital anomalies have laboratory evidence of CRS. 10–30% of adolescent females and 12–30% of women in the reproductive age-group are susceptible to rubella infection in India. RCVs are highly immunogenic in Indian adolescents and women. The coverage data of RCVs in India is not available. However, the coverage of MMR vaccine has been reported as 42%, 30% and 5% from Delhi, Chandigarh and Goa, respectively.ConclusionThis systematic review identifies and explores factors associated with the prevalence of CRS in India. There is a need for urgent action in terms of revamping the national immunization policy and introduction of RCVs in the national immunization program. Active surveillance of rubella and CRS is needed to redress the burden of CRS in India.

Vincristine induced neurotoxicity in cancer patients

Ten out of 20 children, treated with usual doses of vincristine for various types of childhood cancers, developed neurotoxicity during treatment. Peripheral neurotoxicity (mixed motor-sensory 4/10, pure motor 3/10, pure sensory 3/10) was seen in the form of weakness of lower limbs, areflexia, neuropathic pain, or sensory loss. Autonomic neuropathy presented as constipation and urinary retention in 2 children, while 2 children developed encephalopathy in form of seizures, confusion, aphasia, and transient blindness. In children with severe neuropathy, vincristine administration was withheld/dose reduced till clinical improvement started, which took about 2–3 weeks time. Nerve conduction velocity showed motor-sensory axonal polyneuropathy. Electrophysiological abnormalities were found to persist even six months after clinical recovery in children with neurotoxicity. We found a relatively higher incidence of vincristine induced neuropathy in Indian children, which was probably due to coexistence of severe malnutrition in them.

Mid-upper arm circumference v. weight-for-height Z-score for predicting mortality in hospitalized children under 5 years of age.

OBJECTIVE To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age. DESIGN Diagnostic test accuracy study. SETTING Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India. SUBJECTS Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome. RESULTS One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<-3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<-3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually. CONCLUSION MUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<-3. It should be measured in all emergency settings to identify the children at higher risk of death.

Vitamin D supplementation for treatment and prevention of pneumonia in under-five children: A randomized double-blind placebo controlled trial

ObjectiveTo evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in underfive children.DesignRandomized, double blind, placebo-controlled trial.SettingTertiary-care hospital.Participants324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL).Intervention100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment.Outcome variablesPrimary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness.ResultsMedian (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention.ConclusionThere is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

Isolated cerebellar ataxia: an early neurological complication of enteric fever

Abstract Enteric fever is associated with a variety of clinical presentations and complications. Although central nervous system involvement is not uncommon in enteric fever, acute cerebellar ataxia as a presenting feature is rare. A 7-year-old boy with enteric fever who presented with acute cerebellar ataxia is reported.

Uncommon presentation of neurocysticercosis

Non-epileptic manifestations of neurocysticercosis (NCC) include intellectual deterioration, dementia and parkinsonian behaviour. We report on a child with NCC presenting with abnormal choreiform movement. The case report highlights an uncommon presentation of NCC, and also draws attention to an unusual cause of chorea in children from tropical regions.

A Writers Dilemma: Where to Publish and Where not to?

Journals are the essence of scholarly communication. They not only serve to disseminate latest scientific advancements but also provide a platform for archiving scholarly information for future reference, and allow a researcher to assert his scientific mettle. Selecting the most suitable journal to showcase one’s scholarly work is no mean feat. With more than 43,000 biomedical journals listed with PubMed [1], the database maintained by United States National Library of Medicine (NLM), this exercise can easily flummox an inexperienced researcher. The huge risk of rejection of a paper from a journal that is not the right fit, and a widening web of dubious and predatory journals which publish almost everything sent to them, make this task particularly daunting.

Oral zinc supplements are ineffective for treating acute dehydrating diarrhoea in 5–12‐year‐olds

Many countries have guidelines recommending the use of oral zinc in acute dehydrating diarrhoea in children aged 2 months to 5 years of age, but no guidelines exist for older children. This study tested how effective existing recommendations are in children from 5 to 12 years of age.

Oral dextrose for analgesia in neonates during nasogastric tube insertion: a randomised controlled trial.

This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates.