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

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