Tapas K. Sabui

A Randomized Controlled Trial to Evaluate the Efficacy of Lactobacillus GG in Infantile Diarrhea

In a randomized, double-blind, placebo-controlled trial, 229 infants hospitalized for acute diarrhea in rural India were given a 10-day course of Lactobacillus rhammosus GG (minimum dose, 10 degrees bacteria) or placebo. There was no difference in groups in the duration of diarrhea or numbers of stool on days 3, 6, or 10 of treatment.

A Prospective Study of Rotavirus Diarrhea in Children Under 1 Year of Age

The aim of this study was to document the changing clinical profile and prognosis of acute diarrhea in infants. This was a prospective observational study with follow-up. Demographic, anthropometric, and clinical data were collected in children younger than 1 year with acute diarrhea. Stool was examined under the microscope, cultured, tested for presence of reducing substance and occult blood, and subjected to electrophoresis to detect rotavirus infection. Thirty-one (91.2%) of the 34 infants were breastfed, 18 exclusively and 13 partially. Twenty-three had rotavirus infection and had slower nutritional recovery than others. There was no difference in the incidence of rotavirus infection between exclusively and partially breastfed infants. Continuation of feeds containing lactose did not affect prognosis, though 23 (67.6%) infants had reducing substance in stool. We documented a high incidence of rotavirus infection, which negatively affected growth of infants by some ill-defined mechanism. Failure of exclusive breastfeeding to protect against rotavirus infection highlights the need for universal rotavirus vaccination. Lactose malabsorption detected in many infants did not affect prognosis after acute diarrhea.

The emergence of Kawasaki disease in India and China

Kawasaki disease (KD) is recognized as a leading cause of acquired heart disease in children in developed countries. Although global in distribution, Japan records the highest incidence of KD in the world. Epidemiological reports from the two most populous countries in the world, namely China and India, indicate that KD is now being increasingly recognized. Whether this increased reporting is due to increased ascertainment, or is due to a true increase in incidence, remains a matter of conjecture. The diagnosis and management of KD in developing countries is a challenging proposition. In this review we highlight some of the difficulties faced by physicians in managing children with KD in resource-constrained settings.

Clitoral length and anogenital ratio in Indian newborn girls

ObjectivesTo generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns.DesignCross-sectional study.SettingNeonatal unit of a tertiary care teaching hospital in Kolkata.Participants378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities.InterventionsMeasurements were recorded using a digital vernier caliper between 24–72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured.Main outcome measuresGestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios.ResultsMean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance.ConclusionsThe normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.

Survey of musculoskeletal abnormalities in school-going children of hilly and foothill regions of Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine screening method.

To study the prevalence and pattern of musculosketetal abnormalities in school‐going children living in the hilly and foothill regions of the Eastern Himalayas using the pediatric Gait, Arms, Legs, Spine (pGALS) screening tool.

Musculoskeletal manifestations in pediatric patients infected with human immunodeficiency virus: Developing country perspective

Objective Musculoskeletal manifestations in children infected with human immunodeficiency virus (HIV) are responsible for increased morbidity and decreased quality of life. Even in this era of highly active anti-retroviral therapy (HAART), there are limited studies on different rheumatological manifestations in pediatric patients with HIV, and the spectrum of musculoskeletal manifestation in pediatric HIV is yet to be established. Methods A single-center, prospective, observational study was carried out from October 2014 to September 2016 in a tertiary care hospital of Eastern India with 517 children infected with HIV aged between 3 and 19 years. Particulars of musculoskeletal involvement were at first screened with pediatric gait, arm, leg, spine (pGALS) screening protocol, followed by detailed examination in patients identified through screening. All the participants were re-examined at three and six months of follow-up. Results Musculoskeletal manifestations were found in 11.2% of the study population. The most common non-infective manifestation found in the study population was arthralgia (5.22%), followed by myalgia (3.29%). The prevalence of definite arthritis was found to be 6/1000 children, whereas infective manifestations (including arthritis, myositis, and osteomyelitis) were found in 2.12% of study population. Musculoskeletal manifestations were commonly found in children infected with HIV who were on anti-retroviral drugs. These manifestations were found commonly in the children in the second decade of their lives. Malnutrition, advanced stage of HIV infection (WHO clinical stage 4), lower CD4 count at the time of evaluation, and longer duration of disease were associated with increased frequency of musculoskeletal manifestations. Conclusion Musculoskeletal manifestations are frequent in pediatric population infected with HIV. But for better delineation, further multicentric studies are warranted in future in children infected with HIV.

Childhood lupus nephritis: 12 years of experience from a developing country’s perspective

Objective To assess the long-term outcome of lupus nephritis in children with systemic lupus erythematosus followed up over 12 years at a tertiary care teaching hospital in Eastern India. Material and Methods This is a retrospective observational study of the clinicopathological presentation, management, and outcome in 46 children with lupus nephritis over a period of 12 years at a tertiary teaching hospital in Eastern India. Mortality was compared between different lupus classes and therapy groups with Kaplan-Meier analysis and log-rank test. Results The incidence of lupus nephritis was 58.97% [95% confidence interval (CI) 48.06%-59.89%] with the mean age at presentation being 10.2±2.43 years (range 5.5-14.5) years. Majority belonged to class IV (30.43%), followed by class II (26.91%), class III (23.91), and class V (8.70%). Outcome analysis of children with lupus nephritis over 12 years revealed that 24 (52.17%) achieved complete remission of disease activity, 5 attained partial remission, 4 continued to have active disease, 5 developed end-stage renal disease (ESRD), and 8 died. Overall mortality thus observed was 17.39% with septicemia in the background of ESRD being the commonest cause. No significant difference in mortality was observed between different lupus nephritis classes or therapy arm groups. Conclusion The study throws light on various aspects of lupus nephritis and their long-term outcome patterns in children from developing countries such as India.