Tabassum Shahab

Effect of nutritional status on total parasite count in malaria

Effect of nutritional status as reflected by weights for age on total malarial parasite count was studied in 75 children. P. vivax was seen in 31 and P. falciparum in 44 of them. In 15 patients with normal weight for age mean absolute parasite count was 12200. The mean total malaria parasite count in PEM grade I was 9741; 4260 in grade II; 4286 in grade III and 596 in PEM grade IV. Statistical evaluation revealed a significant positive correlation (r=0·98) between nutritional status and total parasite count.

Age-specific prevalence of hepatitis B surface antigen in pediatric population of Aligarh, North India.

Objective: To estimate the age-specific seroprevalence of hepatitis B surface antigen (HBsAg) in children upto 14 years of age.Methods: Equal number (115 each) of apparently healthy children of both sexes of different age groups i.e. < 1, 1–4, 5–9 and 10–14 years, attending pediatric outpatient services and Well Baby Clinic of the hospital were tested for HBsAg using ELISA test. Positive results were confirmed by a second ELISA.Results: Overall 4.35% (95%CI, 2.44 –6.25) of the 460 children tested were HBsAg positive. The prevalence rate was the highest (6.09%) in the 1–4 year age category. In the < 1, 5–9 and 10–14 year age groups it was 4.35%, 4.35% and 2.61% respectively. The overall male to female ratio was 2.1:1, with no significant difference in seropositivity rates (P = 0.816).The difference in the prevalence rates between the rural (4.84%) and urban populations (3.77%) was also statistically insignificant (P = 0.577).Conclusion: Average HBsAg positivity in the pediatric population in this region is 4.35% (95%CI, 2.44 –6.25). The prevalence progressively increases and peaks in the 1–4 years age group. It is least in 10–14 years age group.

Spontaneous pneumothorax in children--a review of 95 cases.

We reviewed the records of 95 consecutive patients with spontaneous pneumothorax. The children, 75 boys and 20 girls, ranged in age from newborn to 12 years. The average duration of symptoms, cough, chest pain and breathlessness, was 5 days. Pyogenic lung infection (74.8%) and pulmonary tuberculosis (21%) were the commonest underlying causes of pneumothorax. All children underwent tube thoracostomy drainage along with supportive treatment. Five died owing to sever infection present at the time of admission. Except for the five (5.21%) who died, all children (94.79%) had full relief of pneumothorax. We conclude that pyogenic pulmonary infection and pulmonary tuberculosis are still the commonest causes of pneumothorax in the tropics. Tube thoracostomy drainage is very successful and thoracotomy in selected patients is safe.

Evaluation of salivary anti-Salmonella typhi lipopolysaccharide IgA ELISA for serodiagnosis of typhoid fever in children

This observational study was conducted to determine the diagnostic accuracy of ELISA for the detection of anti-Salmonella typhi lipopolysaccharide (LPS) salivary immunoglobulin A (IgA) antibodies in 37 children with culture confirmed typhoid, 30 febrile controls with an alternative diagnosis and 30 healthy controls. The test was positive in 33/37 (89.2%) cases of typhoid, but negative in all patients in the two control groups. Maximum absorbance of anti-LPS IgA was observed during the second and third weeks of typhoid, with a progressive decline thereafter. The sensitivity of ELISA was 71.4%, 100%, 100%, 9.1% and 0%, in first, second, third, fourth and fifth week of illness, respectively. Further large scale studies measuring salivary anti-LPS IgA antibodies are needed to confirm the potential of saliva-based serology in children with suspected typhoid.

Cerebral malaria in children

Presented here is our experience with 30 cases of cerebral malaria. The diagnosis in all of them was based on a positive smear report. Plasmodium falciparum accounted for 26 cases while P. vivax was responsible for cerebral malaria in the remaining 4. There were 21 males and 9 females. Sixteen children were older than 8 and 9 between 4 and 7, and the remaining 5 less than 3 years of age. Thirty per cent were ill for over a week before reporting for admission; 83 per cent sought hospital care within 24 hours of the appearance of neurological signs. Fever and altered consciousness were present in all the 30 cases while 23 gave a history of convulsion. Isolated cranial nerve palsy of III and VII nerves were also seen on admission. Six children died. All the rest but one made a complete recovery. Of prognostic significance were the pretreatment levels of serum C3 and C4 fraction which were found to be significantly lower (p<0·05) in patients with fatal ending.

Management of Empyema thoracis in children--a study of 65 cases.

Sixty-five cases of pleural empyema (50 boys and 15 girls) were seen between January 1983 and June 1986. Fifty-three of these 65 children were below 10 years of age. Pulmonary infection was the commonest underlying cause. Cough with or without expectoration (98%) and fever (95%) were the commonest symptoms followed by breathlessness (85%) and chest pain (83%). Staphylococcus aureus was isolated from pus and blood in 61% and 18% of cases, respectively, while pseudomonas was grown in 8% and 3%. Most of the children (88%) were treated with antibiotics and tube thoracostomy drainage. Decortication was needed in 12% of cases. There were four deaths in this study. The overall success rate was 94%.

Profile and risk factors for congenital heart defects: A study in a tertiary care hospital

Introduction: Congenital heart defects (CHDs) are an important cause of mortality and morbidity in children representing a major global health burden. It is thus important to determine their prevalence and spectrum and identify risk factors associated with the development of heart defects. Materials and Methods: A case-control study was carried out in the Department of Pediatrics and Center of Cardiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from February 2014 to August 2015. All patients referred with complaints or clinical examination suggestive of CHDs were further evaluated with echocardiography. On Echocardiography, patients having CHDs were included as cases and those having a normal echocardiographic study were included as controls. Healthy controls were also included. 400 cases and 400 controls were thus identified; preterms having patent ductus arteriosus and patent foramen ovale and those with acquired heart defects were excluded. Risk factors among cases and controls were further studied. Results: Acyanotic heart defects were 290 (72.50%) of the total heart defects, whereas the contribution of cyanotic heart defects was 110 (27.50%). Out of all CHDs, ventricular septal defect was the most common lesion with contribution of 152 (38%) cases, whereas among the cyanotic heart defects, Tetralogy of Fallot was the most common lesion (18% of total cases). Out of the total 400 cases, 261 were males (65.25%). On univariate analysis, paternal age (odds ratio, OR, 2.01), bad obstetric history (OR, 2.65), antenatal febrile illness (OR, 4.12), and advanced maternal age (OR, 3.28) were found to increase the risk of CHD whereas intake of multivitamin (OR, 3.02) was found to be protective. The risk factors were further analyzed with multivariate logistic regression analysis and all the above factors were found to be significantly associated. Conclusion: We noted that the profile of CHD in our population was similar to the published literature although many were missed during infancy and detected later in life. Several antenatal factors were found to be associated with the incidence of congenital heart disease emphasizing the need to prioritize antenatal care and counseling to pregnant mothers along with good maternal nutrition and folic acid supplementation.

Clinical profile of malaria in children—a prospective study from Aligarh (N. India)

In a prospective, hospital-based study in North India, malaria accounted for 1.5% of paediatric outpatient attendances during 1 year. A marked increase in the prevalence of malaria was noted during the post-monsoon months. Plasmodium falciparum was the causative species in 44.4% of cases, contrary to previous reports of low prevalence of this parasite in the area. Pyrexia with or without chills or rigor, vomiting, pallor and hepatosplenomegaly were the common presenting clinical features. Splenic and hepatic enlargement were seen more frequently with P. vivax than P. falciparum infections (P less than 0.001 and P less than 0.01, respectively). Convulsions were present in 20% of cases.

Addition of a Short Course of Prednisolone to a Gluten-Free Diet vs. Gluten-Free Diet Alone in Recovery of Celiac Disease: A Pilot Randomized Controlled Trial

Background A gluten-free diet (GFD) is the standard of care in the management of patients with celiac disease, but clinical and histological recovery are often delayed. In newly diagnosed patients, strict compliance to GFD is difficult to achieve; this is especially true in developing countries where gluten-free food is often difficult to obtain. Steroids, when used alone, can be effective in inducing recovery in patients with celiac disease. We performed a randomized controlled trial to study the effect of a short course of prednisolone combined with a GFD on the recovery of celiac disease. Materials and methods This study was a single-center, randomised, open-label trial. This investigation was done in a pediatric gastroenterology unit of a tertiary teaching hospital in north India.Twenty-eight newly diagnosed celiac disease patients were enrolled in the study. Prednisolone was given at 1 mg/kg for four weeks; duodenal biopsies and IgA anti-tissue transglutaminase (tTg) levels were assessed at eight weeks, six months, and 12 months from the start of the study. Outcome measures The primary outcome measures used to indicate clinical, histological, and immunological recovery of celiac disease were clinical improvement at eight weeks and the proportion of patients with improved histology by at least one grade and who were tissue transglutaminase (tTg) seronegative at eight weeks. The secondary measures were the proportion of patients showing normalization of histological features and the proportions of patients becoming seronegative at six months and one year of GFD. Results Patients were randomized into the GFD only (n = 14) or GFD with prednisolone (GFD+P) (n = 14) groups. No significant differences were detected in clinical recovery at eight weeks; none of the patients became seronegative at eight weeks, six months, or 12 months. The proportion of patients with improvement in histology by at least one grade was higher in the GFD+P group at eight weeks, and there was no difference in overall histological improvement at 12 months after starting treatment. Conclusion The addition of a short course of prednisolone to a GFD does not affect clinical and serological recovery but might result in rapid histological recovery compared to a GFD alone in patients newly diagnosed with celiac disease.

Prevalence of pulmonary arterial hypertension on echocardiography in newborns with maternal risk factors

Persistent Pulmonary Hypertension of Newborn (PPHN), considered an extreme form of PAH, can be defined as a failure of normal fall in pulmonary vascular resistance (PVR) at or shortly after birth, leading to shunting of unoxygenated blood into the systemic circulation across foramen ovale or ductusarteriosus.1 PPHN physiology mimics the fetal circulation in which PVR exceeds SVR and right to left hemodynamic shunting occurs through foramen ovale and/or ductus Arteriosus.1