Rashmi Dwivedi

Effectiveness of 3-Day Amoxycillin vs. 5-Day Co-trimoxazole in the Treatment of Non-severe Pneumonia in Children Aged 2-59 Months of Age: A Multi-centric Open Labeled Trial

This cluster randomized, open labeled trial was conducted to compare the effectiveness of 3 days of oral amoxycillin and 5 days of co-trimoxazole treatment in terms of clinical failure in children with World Health Organization (WHO) defined non-severe pneumonia in primary health centers in rural India. Participants were children aged 2-59 months with WHO defined non-severe pneumonia, with or without wheeze, who were accessible to follow up. From seven primary health centers in each arm, 2009 cases were randomized, 993 and 1016 in treatment with amoxycillin and co-trimoxazole, respectively. Fever was present in 1247 (62.1%) and wheeze in 443 (22.1%). There was good adherence and low loss to follow-up. Clinical failure on amoxycillin and co-trimoxazole on intention to treat analysis was 137 and 97, respectively (absolute difference = 0.04, 95% confidence interval: - 0.035-0.12). We conclude that there was no difference in effectiveness of oral co-trimoxazole or amoxycillin in treating non-severe pneumonia.

Quality of life in children with epilepsy.

Background: Epilepsy is a chronic medical condition with many co-morbid features. It has been observed that children with epilepsy (CWE) have a compromised quality of life (QOL). Objective: To assess the QOL in CWE and to study the various factors affecting QOL among CWE. Materials and Methods: The sample consisted of 102 CWE aged 5–15 years of either sex. QOL was measured by Quality of Life in Childhood Epilepsy (QOLCE) questionnaire, a 76-item, parent-reported questionnaire. Cronbach alpha was used to determine the internal consistency of the subscales and Pearson correlation to determine construct validity. The t-test and analysis of variance were used to compare mean QOLCE scores. Results: Factors affecting QOL included age, place of residence, socioeconomic condition, maternal education, seizure type and frequency and number of antiepileptic drugs. Conclusion: CWE have a relatively compromised QOL and comprehensive care needs to go beyond the attempt of controlling seizures.

Nucleated red blood cell in cord blood as a marker of perinatal asphyxia.

Background: Perinatal asphyxia is a major cause of neurological morbidity and mortality in India. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. Methods: A prospective (case-control) study was undertaken at Gandhi Medical College and Associated Hospitals. A total of 100 neonates were included in the study. Levels of NRBC/100 white blood cells (WBC) and absolute NRBC counts in cord blood were compared for 50 asphyxiated (case group) and 50 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. Results: The number of NRBC/100 WBC in the blood of 50 newborns each in the asphyxiated and in the control group were mean 29.5 ± 26.0, range 7-144 NRBCs/100 WBC and mean ± standard deviation 5.9 ± 2.6, range 3-14 NRBCs/100 WBC respectively (P < 0.01). Using quartile deviation, staging of hypoxic ischemic encephalopathy (HIE) was done on basis of NRBC count and there was 80% agreement between clinical and NRBC staging of HIE. There was a significant (P < 0.01) correlation of the number of NRBC\100 WBC with Apgar scoring, HIE staging and mortality. Conclusions: The NRBCs/100 WBCs can be used as a simple marker for the assessment of severity and early outcome of perinatal asphyxia.

Assessment of iron status and red cell parameters in healthy full term small for gestational age neonates at birth

Background: Hematological values of the newborn babies vary according to the gestational age and intrauterine growth. Objective: The objective of this study is to compare the iron status and red cell parameters in healthy term small for gestational age (SGA) and appropriate for gestational age (AGA) neonates. Materials and Methods: A prospective hospital based study was conducted in a tertiary care teaching institution of central India. 50 AGA and 50 SGA neonates were included in the study and serum iron, serum ferritin and red cell parameters (hemoglobin (Hb), red blood cell (RBC) count and hematocrit (Hct), mean corpuscular volume (MCV), means corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW]) were estimated within 24 h of birth. Results: Serum ferritin levels were significantly low in SGA neonates as compared with AGA (mean 103 vs. 158 ng/ml; P=0.001) neonates. In SGA neonates, mean values of Hb (P=0.001), RBC count (P=0.018) and Hct (P=0.005) were significantly higher than in AGA neonates. Higher values of RDW and MCV were seen in SGA group in comparison with AGA neonates. Similarly, lower values of serum iron, MCH and MCHC were seen in the same group; although, these were non-significant. Conclusion: Despite higher Hb content, SGA neonates are deficient in iron store at birth as indicated by lower serum ferritin levels in them and early iron supplementation should be considered in them.

Ingestion of Phenol (Carbolic Acid) Leading to Ventricular Fibrillation.

To the Editor: Phenol (IUPAC name) is a benzene derivative, which is used as a disinfectant. Phenol and its derivatives have a toxicology rating of 4 [1]. It is a highly toxic chemical and a protoplasmic poison [2]. A 7-y-old child was brought pulseless and in respiratory distress to ER early in the morning. The mother gave a history of ingestion of some unknown substance 30 min back. The child was immediately intubated and put on mechanical ventilator. Fluid resuscitation was done for shock followed by which inotropes were added. The child had tachycardia with irregular heart rate; cardiac monitor showed ventricular fibrillation. ECG was taken and after cardiologist’s opinion IV lignocaine was started with a loading dose and was continued for 24 h (Fig. 1). Meanwhile, the chemical was sent for analysis. The analysis confirmed the chemical as phenol. Ventricular fibrillation responded to lignocaine in 18 h (Fig. 2). The child could be extubated after 3 d. The child had not developed any burns in the esophagus and was started with liquid diet which he accepted well. Barium swallow done at day 7 was normal and so also the upper GI endoscopy which was done after 21 d. Phenol is absorbed within 30 min of ingestion and is excreted in the urine [3]. The average fatal dose is 25– 50 ml of household phenol [4, 5]. It causes damage to the oral, esophageal and gastric mucosa and leads to bleeding and perforation. It is a respiratory depressant and causes respiratory failure. There occurs a rise in blood pressure after phenol absorption initially followed by shock. Cardiac arrthymias are reported to occur after 60 min of ingestion of phenol [4]. Our patient developed ventricular fibrillation, which was treated successfully with injection lignocaine. As the child ingested small quantity and rinsed his mouth immediately with water, this has probably saved GI mucosa from damage. The time elapsed from ingestion to medical management was only 30 min which contributed to uneventful recovery. Phenol is a household disinfectant and thus easily accessible. It should be kept in labeled bottles out of reach. As there is no antidote to phenol, early and prompt cardiovascular resuscitation and timely detection and management of abnormal cardiac rhythm is life saving. * Poorva Gohiya gohiyapoorva@gmail.com

An Investigation on Breast Feeding Practices in Normal Newborn Babies During Institutional Deliveries in Bhopal District of Madhya Pradesh

The Present study makes an attempt to analyze the Breast feeding practices in normal Newborn babies in institutional Deliveries and also to investigate time of initiation of Breast feeding practices and type of feeds given to the normal newborn babies in Institutional Deliveries. The study was conducted in the Department of Paediatrics & Obstetric and Gynaecology, Gandhi Medical College, Bhopal. The study was based on primary data with help of observational study during the period from August 2008 to September 2009 with sample size 500 cases. The findings of the study revealed that, distribution of newborns according to the time of initiation of breast feeding was found to be in high within half an hour to five hours duration. The new born male babies were high (77.9 per cent) when compared to female babies (68.49 per cent) during half an hour to five hours duration. Further, study results on type of delivery revealed that, 82.6 percent of babies were delivered by normal vaginal delivery (NVD) and 17.4 percent of babies were delivered by lower segment caesarean section (LSCS). The Study also focused on type of pre-lacteal feeds given to the newborns, the outcome the study shows that, more than 50 percent of mothers practiced pre-lacteal feeds of one sort or the other which includes Cows milk (39.8%), Tea (27.2%), Honey (14.9%), Goats Milk (11.11%) and Glucose water (6.89%). Hence, the study suggests that, breastfeeding should be made to all normal newborns (including those born by caesarean section) as early as possible after birth, ideally within half an hour to five hours duration. The Colostrum, which is secreted within first 2-3 days, must not be leftover but should be fed to newborn as it contains high concentration of defensive immunoglobulins and cells which provides an optimal nutrition to child and prevent from infections. Health service providers have significant role in not only promoting optimal breast feeding practices but also in ensuring these practices are followed.

Familial clustering of a rare syndrome

Ectrodactyly, ectodermal dysplasia and cleft palate syndrome is a rare autosomal dominant multiple congenital anomaly syndrome with variable expressivity and reduced penetration. The cardinal features are cleft palate/lip, lobster hand deformity, sparse hypopigmented hair, dry scaly skin, and lacrimal and urogenital anomalies. A neonate presented to us with typical features, his mother and other two siblings were also affected.