Secondary infection in immuno-competent children with dengue: Case series

The occurrence of bacterial superinfection, or coinfection, in patients with dengue, has been previously reported,but the available information comes from anecdotic reports. We report clinical and pathological data of immunocompetentchildren diagnosed with dengue and had evidence of concurrent bacterial infections

A Generative Model For Zero Shot Learning Using Conditional Variational Autoencoders

Zero shot learning in Image Classification refers to the setting where images from some novel classes are absent in the training data but other information such as natural language descriptions or attribute vectors of the classes are available. This setting is important in the real world since one may not be able to obtain images of all the possible classes at training. While previous approaches have tried to model the relationship between the class attribute space and the image space via some kind of a transfer function in order to model the image space correspondingly to an unseen class, we take a different approach and try to generate the samples from the given attributes, using a conditional variational autoencoder, and use the generated samples for classification of the unseen classes. By extensive testing on four benchmark datasets, we show that our model outperforms the state of the art, particularly in the more realistic generalized setting, where the training classes can also appear at the test time along with the novel classes

Neuroimaging in Cerebral Palsy – Report from North India

How to Cite This Article: Aggarwal A, Mittal H, Debnath SKR, Rai A. Neuroimaging in Cerebral Palsy–Report from North India. Iran J Child Neurol. 2013 Autumn; 7(3):41- 46. ObjectiveOnly few Indian reports exist on neuroimaging abnormalities in children with cerebral palsy (CP) from India. Materials & MethodsWe studied the clinico-radiological profile of 98 children diagnosed as CP at a tertiary centre in North India. Relevant investigations were carried out to determine the etiology. ResultsAmong the 98 children studied, 80.5% were males and 22.2% were premature. History of birth asphyxia was present in 41.9%. Quadriplegic CP was seen in 77.5%, hemiplegic in 11.5%, and diplegic in 10.5%. Other abnormalities were microcephaly (60.5%), epilepsy (42%), visual abnormality (37%), and hearing abnormality (20%). Neuroimaging was abnormal in 94/98 (95.91%).Abnormalities were periventricular white matter abnormalities (34%), deep grey matter abnormalities (47.8%), malformations (11.7%), and miscellaneous lesions (6.4%). Neuroimaging findings did not relate to the presence of birth asphyxia, sex, epilepsy, gestation, type of CP, or microcephaly. ConclusionsNeuroimaging is helpful for etiological diagnosis, especially malformations.  ReferencesSinghi PD, Ray M, Suri G. Clinical spectrum of cerebral palsy in north India-an analysis of 1000 cases. J Trop Pediatr 2002 48(3); 162-6.Sharma P, Sharma U, Kabra A. Cerebral Palsy-Clinical Profile and Predisposing Factors. Indian Pediatr 1999;36(10):1038-42.Nelson KB, Ellenberg JH. Antecedents of cerebral palsy. Multivariate analysis of risk. N Engl J Med 1986 315(2):81-6.Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Dev Med Child Neurol 2007; 49(2):144-51.Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14.http://www.newbornwhocc.org/pdf/database.pdfRikomen R, Raumanvrita S, Sinivuori E, Seppala T. Changing pattern of cerebral palsy in southwest region of Finland. Acta Pediatr Scand 1989; 78(4):581-7.Pharaoh POD, Plat MJ, Cooke T. The changing epidemiology of cerebral palsy. Arch Dis Child 1996;75(3): F169-73.Eischer PS, Batshaw M. Cerebral Palsy. Ped Clin North Am 1993;40(3):537-51.Bax M, Tydeman BA, Flodmark O. Clininical and MRI correlates of cerebral palsy: the European Cerebral PalsyStudy. JAMA 2006; 296(13):1602-08.Korzeniewski SJ, Birbeck G, DeLano MC, Potchen MJ, Paneth N. A systematic review of neuroimaging for cerebral palsy. Journal of Child Neurology 2008;23(2):216-27.Robinson MN, Peake LJ, Ditchfield MR, Reid SM. Magnetic Resonance imaging findings in population based cohort of children with cerebral palsy Dev Med Child Neurol 2009; 51(1):39-45.Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, et al. Practice parameter: Evaluation of the child with global developmental delay: Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology 2003; 60(3); 367-80.Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, et al. Practice parameter: diagnostic assessment of the child with cerebralpalsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 23;62(6): 851-63.

Poland syndrome: Atypical presentation and review of literature

Poland syndrome is a rare congenital disorder with absent or hypoplastic pectoralis major and hand anomalies. Dextroposition,female predisposition, and the left-sided anomalies in Poland syndrome are rarely reported in literature. We report a female babywho was born with chest wall defects, left hand anomalies, dextroposed heart, and hypoplastic ribs. She was diagnosed as Polandsyndrome and managed conservatively

Clinicolaboratory profile of children with celiac disease in North India

Background: Prevalence of celiac disease (CD) has increased worldwide, but there are only few studies reporting clinicolaboratory profile of children with CD. Aim: To study the current clinicolaboratory profile of celiac disease in North Indian children. Methods: This retrospective study was done in pediatric gastroenterology clinic of a tertiary care center of North India. The primary objective was to study clinical and laboratory profile in children with CD. Secondary objective was to find correlation between duodenal biopsy Marsh stage and IgA tissue with tissue transglutaminase antibody (tTG) titers and also with serum hemoglobin, serum iron levels, and severity of anemia. A total of the 54 children fulfilling the diagnostic criteria of CD were included, and details were reviewed and analyzed. Results: Average age of onset of symptoms was 4.7±2.5 years, 80% had onset of symptoms after 2 years of age. Chronic diarrhea (70.3%), pain abdomen (62.9%), and abdomen distention (53.7%) were the most common manifestations. Wasting (38.4% - <5 years, 41.4% in >5 years), stunting (46.3%), rickets (22%), and anemia (90.7%) were common. Serum hemoglobin levels and serum iron levels were inversely correlated to the serum tTG levels and Marsh biopsy staging; though, not significant. Correlation of hemoglobin levels between Marsh stage 3A and 3C was statistically significant (p=0.036). There was no correlation between serum tTG levels and Marsh biopsy staging with anemia and its severity. Conclusion: Gastrointestinal symptoms still remain the most common presentation in children with celiac disease. Malnourishment, anemia, and rickets require special attention in these children

Clinicolaboratory predictors of hospitalization (>7 days) in children with swine flu infection: A retrospective study from North India

Background: High morbidity and mortality of swine flu in children result in frequent hospitalization. Clinical and laboratory parameters predicting the duration of hospitalization are important but not studied in children till date. Aim: This study aims to evaluate the clinical and laboratory predictors of hospitalization (>7 days) and clinicodemographics in children with swine flu infection. Materials and Methods: This retrospective study was done in the department of pediatrics of a tertiary care center in Delhi. The records of children between the age group of 1 and 14 years of age in the previous 3 years and having clinical symptoms and real-time polymerase chain reaction positive for H1N1 infection were included in the study. Baseline characteristics, clinical details, laboratory profile, and treatment of these patients were recorded and analyzed. The outcome parameters were compared between Group A (children hospitalized for ≤7 days) and Group B (hospitalized for >7 days) by appropriate statistical analysis. Results: Of 51 children analyzed, the mean age was 45.83 months and three-fourth of them were ≤5 years (50% of infants). The mean duration of hospitalization in Group A and Group B was 5.09±1.82 and 11.2±4.51 days, respectively. Patients with longer duration of breathlessness (mean difference 1.75 days, p=0.026), hypoxemia, cyanosis, and neutrophil/lymphocyte (N/L) ratio <2 after 48 h of admission were associated with prolonged hospitalization (p<0.05). Mean temperature at admission, absolute neutrophil counts, absolute lymphocyte counts, C-reactive protein levels, arterial blood gases parameters, or percentage of children with fever, altered sensorium, respiratory distress, anemia, leukocytosis, and N/L<2 at admission were comparable between the two groups (p>0.05). The most common presenting symptoms were fever (98%), cough (98%), rhinorrhea (88%), and breathing difficulty (88%) with asthma as the most common comorbid factor. Conclusion: The swine flu is a mild illness with highest hospitalization in children <5 years with non-specific clinical and laboratory features. Breathlessness of longer duration, hypoxemia, cyanosis, and N/L ratio <2 after 48 h of admission were risk factors for hospitalization of more 7 days

Impact of an Educational Film on Parental Knowledge of Children with Cerebral Palsy

Parents of children with cerebral palsy (CP) must have knowledge about the disease and its management to improve the outcome. This uncontrolled interventional trial was carried out to evaluate the parental knowledge of CP and assess the impact of an educational programme on it. Preset questionnaires were filled before and 1 week after a single session educational programme using an educational film. Out of a total of 53 subjects, majority (75.5%) were from lower socioeconomic status. Initially, none knew the correct name of child’s illness; afterwards 45.3% could name it. When compared to previous status, there occurred significant improvement in the knowledge of parents after viewing the film with regard to knowing the cause of CP, knowing that motor involvement was predominant in CP, knowledge regarding curability of the disease, and knowledge about special schooling (P0.05). Majority (94.3%) found the film useful and 96.2% learned how they could help in the management of their children. Parental knowledge of CP is inadequate which can be improved by incorporating such educational programmes in special clinics to improve management

Carotid intimal medial thickness in children with celiac disease

Introduction: Increasing cardiovascular risk in celiac disease (CD) may be attributed to the chronic systemic inflammation and unfavorable biochemical profile leading to accelerated atherosclerosis. Carotid intimal medial thickness (CIMT) has emerged as a direct marker of the early atherosclerosis as compared to traditional biochemical markers. Objectives: The aim of this study was to evaluate the CIMT in children with CD aged 1–16 years. Materials and Methods: A cross-sectional observational study was conducted at the department of Pediatrics and Radio Diagnosis in a tertiary care hospital of New Delhi. Thirty-six children with CD with age- and sex-matched controls were enrolled. CIMT for the anterior and posterior walls on each side was measured, and the mean CIMT was obtained for all the enrolled children. Results: The mean right-sided CIMT was significantly higher in cases (0.053±0.009 cm vs. 0.039±0.007 cm, p=0.000). The mean left-sided CIMT did not significantly differ between the groups (0.051±0.009 cm vs. 0.048±0.055 cm, p=0.702). The mean CIMT (right and left together), although higher in Celiacs, was not significantly different from controls (0.052±0.008 cm and 0.044±0.029 cm, p=0.114). However, a significant positive correlation between the age of the patients, age at the onset of symptoms, and CIMT was noted. Conclusion: Although we could not demonstrate statistically significant results, the mean CIMT and the right-sided measurements were significantly higher in cases than in controls