Rajesh Kulkarni

D-transallethrin: An unusual agent for accidental poisoning

D-trans allethrin, a pyrethroid, is commonly used as a coil mosquito repellant. There are very few reports of human toxicity due to D-trans allethrin. We present the case of an 11-month-old boy who presented to us with excessive salivation, altered sensorium and convulsions following alleged accidental ingestion of a coil containing D-transallethrin. He required mechanical ventilation for a brief period and made a full recovery. Although rare, the possibility of pyrethroid poisoning should be kept in mind in children who present with sudden onset unconsciousness or convulsions.

Importance of Temperature, Oxygen Saturation, Perfusion, Sugar (TOPS) Parameters and the concept of TOPS score for Neonatal Transport in India - A pilot Project

Aim: The importance of TOPS parameters (temperature, oxygen saturation, perfusion and sugar) in predicting neonatal outcome is well established and TOPS parameters on admission reflect the care taken before and during transport of neonate while referral. The objective was to introduce the concept of TOPS score from TOPS parameters and to formulate optimal TOPS score (score at which neonatal outcome is the best) which will help regional health centers and peripheral health centers (PHCs) in safely referring newborns. Method: This observational study was carried out from August 2013July 2014. TOPS parameters were taken on admission of neonates referred to our center and outcome of these neonates were noted as survived/dead. When no TOPS parameters were deranged, it was scored as 0. When 1 TOPS parameter was deranged, the score of 1 was given. When 2 TOPS parameters were deranged, score of 2 was given and so on. Optimal TOPS score was defined as the score at which neonatal outcome was best. Effect of TOPS score and outcome was determined Result: Five hundred twenty nine neonates were included in the study, of which 417 (78.8%) survived and 112 (21.2%) died. Hypothermia was present in 315 (59.6%), hypoxemia in 252 (47.6%), prolonged perfusion in 230 (43.5%) and hypoglycemia in 78 (14.7%) babies. One hundred forty five babies had score of 0 of which all survived, this was considered optimal TOPS score. Single TOPS parameter (score 1) was seen in 120 babies of which 117 (97.5%) survived, 91 babies had derangement of 2 TOPS parameters (score 2) of which 79 (86.8%) survived, 119 babies had derangement of 3 TOPS parameters (score 3) of which 65 (54.6%) survived and 54 babies had derangement of all the 4 TOPS parameters (score 4) of which 43 (79.6%) babies survived. Conclusion: Concept of TOPS score is introduced for stressing that derangement of TOPS parameters when found together is more harmful and significantly increases the risk of neonatal mortality. TOPS score sensitizes the need to attempt at achieving optimal TOPS score by taking care of the easily correctable conditions of hypothermia, hypoxemia, poor perfusion and hypoglycemia before and during the referral of neonate. ARTICLE HISTORY Received 08 February 2018 Accepted 12 June 2018

Anaemia in HIV infected HAART naïve and HAART exposed children

Background: The 2016 UNAIDS report estimates about 2.1 million people living with HIV in India, of whom about 7 per cent are children under the age of 15 year. The primary objective of this study was to analyze the prevalence of anaemia in HIV Infected HAART naïve and HAART exposed children. The secondary objectives were to analyze the type of anaemia and correlation of anaemia with dietary habits and associated opportunistic infections. Present study was a cross-sectional, observational study carried out in pediatric ART OPD and ward of a tertiary care teaching hospital, from June 2011 to May 2013. Methods: Complete haemogram, peripheral smear and CD4 counts were done on 130 children with confirmed diagnosis of HIV infection. CDC staging was used to stratify children. We used Chi square test to determine the association between CDC staging, HAART therapy, diet and opportunistic infection with anaemia. P-value <0.05 was taken as significant. Results: 80% (n = 27) of the children with no immunosuppression, 86% (n = 58) of the children with moderate immunosuppression and 84% (n = 24) children with severe immunosuppression were anemic. There was no statistically significant relation between worsening immunosuppression and prevalence of anaemia (p = 0.715). 88% of the children with no opportunistic infection (n = 72) were anemic, while 76% (n = 34) children with opportunistic infection were anemic. This difference was statistically significant (p = 0.016). 88% (n = 53) of the children on HAART were anemic while 74% (n = 51) of the children not on HAART were anemic. Children on HAART did not have significantly high prevalence of anaemia when compared to children not on HAART (p = 0.99). Anaemia was significantly more common in children consuming vegetarian diet (88%, n = 46) compared to children consuming mixed diet (74%, n = 58, p <0.01). Conclusions: Prevalence of anaemia is similar in children on HAART compared to HAART naïve children and at all stages of immunosuppression. Anaemia was more common in the presence opportunistic infections and in children consuming vegetarian diet. Microcytic hypochromic anemia was most common type of anaemia followed by normocytic normochromic anaemia.