Sowmini P. Kamath

Socioepidemiological determinants of severe acute malnutrition and effectiveness of nutritional rehabilitation center in its management

Background: Severe acute malnutrition (SAM) continues to be the reason for increasing hospitalization and also a major killer disease. Objectives: Identify socio-epidemiological determinants among both groups of SAM and evaluate impact of nutritional rehabilitation center (NRC) in its management. Methodology: A prospective observational study was conducted in a medical college on SAM children aged 6 months to 5 years over 1 year. Socio-epidemiological risk factors were compared in both groups. Therapeutic nutrition was provided as per World Health Organization guidelines. Serial weight monitoring and response criteria were analyzed at the time of discharge. Cases were followed up serially at 1, 2, 3, and 6 months for weight monitoring to assess long-term impact of NRC. Results: A total of 91 cases were enrolled; (Group 1: Group 2: 43: 48). Assessment of risk factors in SAM groups revealed a significant association between late initiation and lack of exclusive breastfeeding with group 1 SAM. Significant referrals (P : 0.001) from anganwadi centers included group 1 SAM. Majority responded to NRC management. Statistically significant weight gain noted at each follow-up in both types of SAM. At the end of 6 months, the recovery rate of group 1 SAM was statistically significant (P : 0.023), total defaulter rate was high (29.6%) and none had relapsed. Conclusion: Though NRC was effective in improving nutrition in SAM, results were not sustained in view of high defaulter rates at follow-ups. There is a need to improvise health education to caregivers, link NRC centers with community health centers for better follow-up and address modifiable socioepidemiological risk factors.

Neonate subcapsular splenic hematoma.

Splenic hematoma is an unusual event in newborn babies. The present study report a two day old infant who presented to us in shok with severe pallor and abdominal distension. Initially ultrasonography of evaluation by ultrasound (US) revealed a left adrenal hemorrhage but was subsequently confirmed to be a subcapsular splenic hematoma by computed tomography (CT) scan of the abdomen. This article highlights the utility of CT scan in diagnosis although review of literature shows ultrasonography to be primary screening investigative modality for abdominal visceral bleeds in the neonatal period.

Perceived responsibilities and operational difficulties of anganwadi workers at a coastal south Indian city

Context: Anganwadi worker (AWW) is an important functionary in integrated child development scheme (ICDS). Aim: To study perceived responsibilities, workload, operational difficulties, and satisfaction level of AWWs. Materials and Methods: Prospective observational cross-sectional study of 66 AWWs using a pre-designed proforma: Analysis using Statistical package for social sciences (SPSS) version 11.5. Results: Pre-school education, house visits, records-keeping were perceived as important activities by 92.4%, 60.6%, and 57.6%, respectively, growth monitoring and immunization by 3% and 4.5%, respectively; 51.5% did not have adequate time for duties, and 74.2% were doing non-ICDS duties. Heavy workload was the major perceived operational difficulty for 66.7% of the respondents. Timely supplementary food was available as per 92.4%. Inadequacies in equipments, workspace, training, and staffing were noted by 47%, 18.2%, 7.6%, 7.6%, respectively. No operational difficulties were seen by 10.6%. Induction job training was provided to 36 (54.5%), and 17/66 (25.8%) felt they were inadequately trained despite yearly refresher courses. Dissatisfaction with monthly honorarium, availability of equipment, supplementary food, and maintenance of registries was reported by 89.4%, 53%, 54.6%, and 43.9%, respectively. Despite this, 62.1% (40/66) were satisfied. Conclusions: Supplementary nutrition, growth monitoring, and immunization of children along with health education though being primary duties were given less emphasis. Heavy workload was the major perceived operational difficulty. Adequate staff, workspace, equipments, timely monthly honorarium should be provided along with training and avoidance of non-ICDS duties would help in achieving the objectives of ICDS.

Neonatal arrhythmia with diaphragmatic eventration

Supraventricular tachycardia is the most common symptomatic arrhythmia in young patients, frequently associated with Wolff-Parkinson-White (WPW) syndrome. We report a case of supraventricular tachycardia with Wolff-Parkinson-White (WPW) syndrome associated with partial eventration of a diaphragm in a neonate.

Neonatal Airway Compromise by a Giant Cervicothoracic Venous Haemangioma

Haemangiomas are most common non-malignant vascular tumours of infancy. Here, we describe an antenatally detected mass over the neck causing compressive respiratory compromise at birth requiring resuscitative measures at birth. The mass showed increased vascularity on Contrast Enhanced Computed Tomography (CECT) with extension upto superior mediastinum. Surgical excision was required following failure to medical measures with steroids and propranolol. Histopathology confirmed it to be a venous haemangioma. This case highlights that these benign lesions may reach large sizes and antenatal detection may help in planning effective delivery and resuscitative measures.

Thalassaemia Trait with Gaucher Disease: A Diagnostic Dilemma

Gaucher Disease is an autosomal recessive disease caused by the accumulation of glucocerebrosidase due to deficiency in lysosomal glucocerebrosidase. Thalassaemia trait is asymptomatic and is usually an incidental diagnosis. Both thalassaemia and Gaucher disease can have similar haematologic manifestations and hence, their coexistence causes diagnostic dilemma. Our patient presented at one-and-a-half years with weakness, pallor, failure to thrive and massive hepatosplenomegaly. Clinical examination and history pointed to a lipid storage disease. Peripheral smear revealed microcytic hypochromic cells and nucleated red cells with haemolytic blood picture. Thalassaemia trait was indicated on haemoglobin variant analysis using High Performance Liquid Chromatography. Liver biopsy, bone marrow aspirate and therapeutic splenectomy revealed Gaucher-like cells. Type 1 Gaucher disease can be clinically asymptomatic as well as present with massive liver and spleen enlargement and involvement of bone marrow. Anaemia, splenomegaly and thrombocytopenia are the usual presentations at diagnosis, similar to the haemoglobinopathies. Gaucher-like cells with normal beta-glucocerebrosidase (pseudo-Gaucher cells) are seen in thalassaemia, leukaemia, mycobacterial infections and myeloma. Gaucher disease coexisting with thalassaemia trait is uncommon. We report the occurrence of thalassaemia trait and Gaucher disease in a child, which resulted in confusion regarding the haematological diagnosis. This report highlights the necessity of independent establishment of the diagnosis in every patient so that appropriate management decisions are taken.