Soumya Patra

A relook at preventive therapy for tuberculosis in children.

Preventive therapy for tuberculosis in children is an important strategy to control pediatric TB in addition to early diagnosis and treatment of infectious cases in the community. In low burden countries, it is an important tool for preventing TB at all ages as the opportunities for re-infection are few. In contrast in high burden countries, preventive therapy though effective in preventing occurrence of disease among infected, can not prevent re-infection—an event of fairly high occurrence in these settings. Children under 5 years of age or immuno-compromised children of any age who have the highest risk of developing infection and disease when exposed are the main focus for preventive therapy in high burden settings. A 6 months therapy with INH continues to be the preferred modality of preventive therapy as efforts are being made to identify a short course preventive therapy using Rifampicin and other drugs.

Gastro-esophageal reflux in early childhood wheezers.

Wheezing is common among infants and young children due to peculiar anatomical and physiological properties of their lungs. Gastro‐oesophageal reflux (GER) has been incriminated as one of the cause of non‐asthmatic wheezing in this age group. The present study evaluates the magnitude of GER and its causal relationship with wheezing in early childhood. All recurrent and persistent wheezers (under two years) were investigated for GER and treated medically where tests were positive. The subjects were further profiled to identify any predictors for GER. Sixty‐seven children of less than 2 years age with recurrent or persistent wheezing were evaluated for GER. Mean age of the study subjects at enrolment was 10.8 months and at onset of wheezing was 7.1 (±u20093.8u2009S.D) months. Asthma and wheeze associated lower respiratory tract infection (WALRI) was diagnosed in about 1/3 each of the patients studied. GER studies were positive in over one‐third (25/67) of cases. Forty‐two percent of children who wheezed by 1 year of age had a positive GER study. Interestingly, nearly half (12/25) of the patients with an abnormal study did not have any clinical suggestion of regurgitation (“silent” GERs). The severity of wheezing was higher among those who had GER versus those who did not (pu2009≤u20090.048; OR: 3.2). However, only 32% patients showed significant response to anti reflux treatment alone while others had partial response. GER, therefore, is an important cause for recurrent wheezing among children less than 2 years of age, either singularly or as a co‐morbidity. The study findings justify investigations for GER among early wheezers; particularly for those who have onset of symptoms by 12 months of age or those who have severe disease. Pediatr Pulmonol. 2011; 46:272–277.

Diagnostic Modalities for Gastro-Esophageal Reflux in Infantile Wheezers

OBJECTIVEnTo compare the diagnostic value of Gastro-intestinal (GI) scintiscan with 24-h pH study in detecting gastro-esophageal reflux (GER) among infantile wheezers.nnnSUBJECTSnFifty-two children < 2 years of age.nnnMETHODSnAll patients, irrespective of symptom underwent study to evaluate for GER.nnnRESULTSnGER studies were positive in almost 45% of cases. The agreement between positivity of these two tests is best among children between 7 and 12 months of age (κ = 0.591, p = 0.002). Overall GI scintiscan was a better test with higher sensitivity and specificity as compared to 24-h pH study when compared with the history suggestive of reflux and clinical response with anti-reflux treatment as standard (p ≤ .001).nnnCONCLUSIONnBoth GER scan and 24-h pH study are complimentary to each other, however, if both the tests are available then GI scintiscan is better as a single test for GER in these early wheezers.

Profile of adolescents with severe anemia admitted in a tertiary care hospital in northern India.

Anemia is common during adolescence. However, severe anemia is uncommon and can have varied etiology. This study was conducted to find out the profile of adolescents (10–18xa0years) admitted for severe anemia. The Case records of children between 10 and 18xa0years old admitted during the year 2008 in Kalawati Saran Children’s Hospital for severe anemia as admitting diagnosis were reviewed. There were 40 patients admitted with severe anemia during the year 2008. This constituted 3.37% of all the admissions. Mean age of these patients was 12 (+/−2.5) years and mean hemoglobin at admission was 3.6 (+/−1.4) g%. Megaloblastic anemia was most common type of anemia (42.5%) followed by aplastic anemia (27.5%) and 15% cases were due to severe iron deficiency anemia. Although iron deficiency anemia is the most common type of anemia, but in adolescents megaloblastic anemia and aplastic anemia should be looked for whenever the adolescents present with severe anemia.

Idiopathic Fanconi's syndrome with nephrogenic diabetes insipidus in a child who presented as vitamin D resistant rickets--a case report and review of literature.

Abstract Fanconi’s syndrome is a complex of multiple tubular dysfunctions of proximal tubular cells occurring alone or in association with a variety of inherited (primary) or acquired (secondary) disorders. It is characterized by aminoaciduria, normoglycemic glycosuria, tubular proteinuria without hematuria, metabolic acidosis without anion gap and excessive urinary excretion of phosphorous, calcium, uric acid, bicarbonate, sodium, potassium and magnesium. Diabetes insipidus is a disease of collecting tubules and a child mainly presents with dehydration and hypernatremia. We report the first case of idiopathic Fanconi’s syndrome along with nephrogenic diabetes insipidus (NDI) in a child who presented to us as resistant rickets. Medline search did not reveal any case of nephrogenic diabetes insipidus associated with idiopathic Fanconi’s syndrome. We hypothesized that the NDI may be due to severe hypokalemia induced tubular dysfunction. The child was treated for hypophosphatemic rickets with severe metabolic acidosis and the treatment for NDI was also given. Now he has healed rickets and normal blood pH, sodium and osmolarity.

Successful intervention in a child with toxic methemoglobinemia due to nail polish remover poisoning

Children are most susceptible to accidental exposure of common household substances and one of the common household substances is nail polish remover. We are presenting a case of accidental ingestion of nail polish remover with lethal methemoglobinemia (serum methemoglobin level-72%). This patient was treated successfully with injection methylene blue. However, even small amounts can be dangerous to children, so it is important to keep this and all household chemicals in a safe place

Antibiotic prescribing pattern in paediatric in patients with first time wheezing

BackgroundAcute wheezers for the first time in life are an important target group for efforts aimed at reducing unnecessary antibiotic use.ObjectiveTo evaluate the effect of clinical, laboratory and radiological data on the decision to prescribe antibiotics to paediatric patients with first time wheezing as well as to seek criteria that would justify antibiotic use.MethodsA prospective study was made of 47 previous healthy children admitted to our hospital with first time wheezing in life between October 2008- March 2009. All the patients were treated as per the treating units protocol with oxygen, bronchodilators with or without antibiotics. The cases were analyzed after discharge and the characteristics of those treated with antibiotics (n = 23) were compared with those who were not (n = 24) and analyzed statistically to find the predictors for antibiotic usage.ResultsThe mean age of the study groups was 5.8 (+/- 5.1) months. Among the clinical and investigational parameters, presence of predominant crackles and abnormalities on radiograph were the major determinants for antibiotic usage. There were no significant differences in final outcome between these groups.ConclusionAntibiotic usage in first time wheezers is still quite prevalent. Presence of crackles and radiological abnormalities often prompt the usage of antibiotics in such cases.

Bilateral Optic Neuritis in Pediatric Systemic Lupus Erythematosus with Antiphospholipid Antibody Syndrome

Bilateral optic neuritis is an extremely uncommon complication of pediatric systemic lupus erythematosus and sporadic cases are reported in the literature. The authors describe an 11-yr-old girl who presented with fever and progressively increasing pallor for 4xa0months, headache for 7xa0days, severe anemia and hepatosplenomegaly. Soon after admission, she developed rapid deterioration of vision, worsening to no perception of light with afferent pupillary defect. Fundoscopy showed bilateral optic neuritis. Investigations revealed autoimmune hemolytic anemia and thrombocytopenia. Anti-dsDNA and anti-phospholipid antibodies were positive. Magnetic resonance venography showed multiple thrombi in the cerebral venous sinuses, for which anticoagulant therapy was initiated. She was managed with intravenous methylprednisolone followed by cyclophosphamide pulse therapy for 6xa0months along with oral prednisolone. Though she went into remission, visual outcome has been dismal, with development of bilateral optic atrophy, and absence of perception of light.

A case report of nephrogenic diabetes insipidus with idiopathic Fanconi syndrome in a child who presented with vitamin D resistant rickets.

Abstract Fanconi syndrome is a complex of multiple tubular dysfunctions of proximal tubular cells, occurring alone or in association with a variety of inherited (primary) or acquired (secondary) disorders. It is characterized by aminoaciduria, normoglycemic glycosuria, tubular proteinuria without hematuria, metabolic acidosis without anion gap and excessive urinary excretion of phosphorous, calcium, uric acid, bicarbonate, sodium, potassium and magnesium. Diabetes insipidus is a disease of collecting tubules and children mainly present with dehydration and hypernatremia. We are reporting the first case of idiopathic Fanconi’s syndrome along with nephrogenic diabetes insipidus in a child who presented to us with vitamin D resistant rickets. Medline search did not reveal any case of nephrogenic diabetes insipidus (NDI) associated with idiopathic Fanconi syndrome. We hypothesized that the NDI may be due to to severe hypokalemia induced tubular dysfunction.

Cor pulmonale in a case of infantile Gaucher's disease

Infantile Gauchers disease presenting as cor pulmonale is rarely reported in pediatric literature. We report a 3.3 year old boy with infantile Gauchers disease who presented to us as interstitial lung disease, pulmonary hypertension along with features of cor pulmonale. The high resolution CT findings were typical of interstitial and airspace disease. Cor pulmonale in this patient was a result of severe pulmonary hypertension.