S. Balasubramanian

Vitamin D deficiency in childhood — A review of current guidelines on diagnosis and management

Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context,it has been reported to be present in majority of children in spite of wide availability of sunlight. Recent guidelines have defined vitamin D status as severe deficiency, deficiency, sufficiency and risk for toxicity as 25(OH)D levels <5, <15, >20 and >50ng/mL, respectively.The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Treatment is necessary for all individuals with deficiency whether symptomatic or not and consists of vitamin D supplementation as Stoss therapy or daily or weekly oral regimens with equal efficacy and safety, combined with calcium supplements. Routine supplementation starting from newborn period is being increasingly endorsed by various international organizations. Prevention by sensible sunlight exposure, food fortification and routine supplementation are the currently available options for tackling this nutritional deficiency.

Dengue viral infection in children: a perspective

Dengue is a vector-borne viral infection of global importance. Several pathogenetic mechanisms such as immune enhancement and selection pressure have been proposed and febrile, critical and recovery phases have been identified. A new classification proposed by WHO has recently been introduced where definitions have been changed to ‘probable dengue’, ‘dengue with warning signs’ and ‘severe dengue’. The majority of dengue viral infections are self-limiting, but complications have high morbidity and mortality. The diagnosis of dengue viral infection is essentially clinical, although confirmation requires laboratory tests including serology, NS1 antigen detection, PCR and viral cultures. There are no specific anti-dengue drugs and treatment is basically supportive and consists of early recognition of complications and appropriate fluid therapy. A number of candidate vaccines are under development.

Factors associated with delay in diagnosis of Kawasaki disease in India.

A retrospective analysis was carried out to identify factors associated with delay in diagnosis of Kawasaki disease in a tertiary care pediatric hospital setting in Chennai, India. Over a period of 2 years, a total of 37 cases were studied. The cases were divided into Early Diagnosis Group (EDG) and Delayed Diagnosis Group (DDG) with the cut-off for early diagnosis being ten days. A greater proportion of cases in the EDG presented primarily to our institution (P=0.004). In the DDG group greater number of cases had received medical attention from practicing pediatricians prior to referral. There was greater interval in onset of individual symptoms in the DDG group. There was no difference between the two groups with regard to age, gender, total blood counts, CRP, liver enzymes, urine analysis or serum albumin values. Platelet counts were higher in the DDG compared to the EDG (P=0.004).Coronary abnormalities were more common in the DDG (P=0.05). Our findings suggest that children presenting primarily to a tertiary care centre with symptoms of Kawasaki disease are more likely to be associated with early diagnosis and delay in onset of neck swelling or oral lesions may be associated with delayed diagnosis. There is a need for creating more awareness about Kawasaki disease among practicing pediatricians in India.