Clinical spectrum of Pediatric HIV across A.R.T. centers in Chhattisgarh

Introduction: Pediatric HIV is a major world health problem, which is progressing at an alarming rate. Few studies have been done about variable clinical manifestation of pediatric HIV infection in children. This study intends to know the clinical profile of HIV infection in children of Chhattisgarh, evaluate the seroconversion rates of babies born to HIV seropositive women, possible maternal, obstetrical, and feeding factors influencing them, patient’s adherence to ART and opportunistic infections in affected children. Methods: All pediatric HIV cases from 1½ year to 14 year registered in A.R.T. centres of Chhattisgarh. Data were analysed using SPSS system version 21. Result: A total of 414 children were evaluated from different A.R.T. centres in Chhattisgarh for final analysis. Male to female ratio is 1.38:1. Most common mode of transmission is from mother to child. Tuberculosis, Recurrent and Persistent Diarrhoea, Recurrent Pneumonia and Oral Candidiasis are common infection in most of the children. Conclusion: Average age of diagnosis of pediatric HIV is around 7.5 ± 2.1years. Majority of children are diagnosed in stage 3. Adherence therapy to A.R.T. is good. Vertical transmission is most common mode of transmission

Correlation between maternal mid upper arm circumference and neonatal anthropometry

Introduction: An infant’s birth weight has been identified as the best marker of optimal fetal growth and development. Maternal anthropometry (weight, height and Mid-Upper Arm Circumference) have been identified to influence an infant’s birth weight and length. If MUAC can be established as a surrogate marker for neonatal anthropometric parameters it will help to plan the timely intervention for improvement of health of pregnant female. Aim: To study the correlation between maternal mid upper arm circumference and neonatal anthropometry. Material and Methods: A cross sectional study conducted in Dr. B R Ambedkar Memorial Hospital & Pt. JNM Medical college Raipur, Chhattisgarh since January 2015 to September 2016. Sample size was 232. Materials like weighing machine, measuring tape, Infantometer, were used. Data was expressed as percentage and correlation was established using Spearman's chi square test (p<0.05). Data was analyzed using SSPS (version 16.0). Result: Significant correlation exists between maternal MUAC and birth Weight and length of neonates. Low birth weight is higher in female neonates. Birth length is higher in male neonates. MUAC of mother is a good predictor of risk of low birth weight as compared with other classic anthropometric measurements. Conclusion: Maternal MUAC is a significant predictor of neonatal anthropometry and can be used instead of pre- pregnancy weight to assess maternal nutritional status especially in resource poor setting

Prevalence of obesity among school children aged 6-18 years with special reference to differences in government and private schools

Introduction: In the society which is switching towards Non communicable diseases, lack of physical activity and luxurious lifestyle and long sitting area in schools have contributing a lot to emerging obesity in school age group students. Overweight and obesity in childhood continues in adulthood and increases the burden of cardiovascular disease. Aims: is to study the prevalence of obesity among school children aged 6-18 years in government and private schools in Raipur City of Chhattisgarh with Objectives being to evaluate association of some modifiable risk factors. Material and Methods: A cross sectional study conducted in urban schools of Raipur from March15 to April-16. Equal number of government (15) and private schools (15) were selected by cluster sampling method and all children of 6 to 18 years age group were studied. Sample size was calculated using formula 4pq/l2 which was 1640. Materials like were weighing machine, measuring tape, portable stadiometer and BMI percentile curves were used. The prevalence of obesity was calculated and associations between modifiable factors were established using Spearman's chi square test. (p<0.05). Data was analyzed using SSPS (version 16.0). Results: Prevalence of obesity is 13.46% among 6-18 in Raipur city and Prevalence of overweight is 10.54% and factors that are significantly associated with obesity are less duration of physical activity, studying in private school, Increased intake of chocolates/drinks and fast food, going school in vehicles, female gender and small playground area in school. Conclusion: overweight and obesity are continuously expanding in our city, proper physical activity routine and dietary habits should be set intricately as best as possible

Clinical spectrum of congenital heart diseases in a tertiary care hospital

Introduction- In developing countries congenital heart diseases (CHDs) causes deaths of thousands of children. A study is necessary to understand incidence and clinical spectrum of CHDs so that early diagnosis and intervention can be done. Material and Methods – Newborns and children up to the age of 14 years attending pediatric OPD as well as admitted in ward with CHDs enrolled for study. Data were analyzed using SPSS system version 21. Results- A total of 400 children with CHDs included for final analysis. Male to Female ratio is 1.78:1.Most common CHDs was Ventricular septal defect followed by Tetralogy of fallot. Major symptoms were cough, difficulty in breathing, poor weight gain and suck rest suck cycle. Maternal risk factors found were consanguinity, maternal diabetes mellitus, maternal hypertension, maternal seizure disorder, maternal obesity, systematic lupus erythematosus etc. Conclusion- VSD is most common acyanotic CHD. Males are more affected with CHDs. Consanguinity and Maternal Diabetes are important risk factors for CHDs

To study the prevalence of cutaneous manifestationsin newborns and its correlation with defined maternal and neonatal factors

Introduction: Newborn skin may look and feel different, depending on the gestational age. Skin manifestations are common in neonates and cause parental anxiety. Many of these are transient and physiological, but some may require further workup to rule out a more serious disorder. Hence, it is of utmost importance for pediatricians and dermatologist to recognize these physiological states in neonates. Objectives: To study incidence of cutaneous manifestations in new born and its correlation with defined maternal and neonatal factors. Material & Methods: Institution based, observational, cross sectional cohort study was conducted in Post natal ward of Dr. B.R.A.M. medical college, Raipur, C.G. Total 4000 neonates were taken in to study. All the neonates irrespective of gestation, up to 3 days of life were included in study, with or without significant maternal history. Detailed dermatological examination was conducted. Obtained data was analyzed by appropriate statistical method. Observation: In all, we studied 18 skin lesions- Epstein pearl 3323 cases (83%), Mongolian spot 2828 cases (70.7%), milia 1344 cases (33.6%), sebaeceous gland hyperplasia 1237 cases (30.9%), erythema toxicum neonatorum 711 cases (17.8%), occipital alopecia 648 cases(16.2%), lanugo 575 cases (14.4%), icterus 548 cases(13.7%), physiological scaling 482 (12.1%), vernix caseosa 9.8%, acrocyanosis 8.6%, salmon patch 7.1%, miniature puberty 6.9%, caput succedaneum 1.6%. Conclusion: In India, Epstein pearl and Mongolian spot are predominant skin lesions. Distribution profile of skin lesions is affected by interracial, environment and hormonal factors

Comparison of survival outcome in early versus late surfactant therapy in preterm neonates with respiratory distress syndrome at a tertiary care centre: A randomized control trial (Open)

Introduction: Prematurity and RDS largely contribute to early neonatal morbidity and mortality. With adequate antenatal steroid and early CPAP, early surfactant therapy improve survival outcome. Material and Methods: Prospective interventional study included newborns with 24-28 weeks prematurity or 28-34 weeks(GA) with clinical RDS and birth weight(BW)>650gms. All subjects were preferably provided early surfactant therapy (within 2hours after birth). Surfactant (Curosurf) was delivered by INSURE technique (Intubate- Surfactant administration- Extubate) and only those who required further respiratory support were ventilated. Records on birth weight, gestational age, timing of therapy (early/late), duration of ventilation, sepsis, complications, and survival/death outcome were collected and data was analysed using SSPS version 17. Results: Out of 100 neonates (49 male, 51 female), 46 received early surfactant therapy and 54 obtained it late; significantly more indoor patients could be treated early (p<0.0001). Although high mortality was observed with both early (65.2%) and late therapy (85.2%), there was significantly higher survival with early therapy (p=0.018). Though no statistical differences of outcome were observed with different GA and BW in study groups; irrespective of timing of therapy, higher mortality occurred in lower BW/GA subgroups with least survival among extremely preterms<27wks(p=0.000057) and ELBW<1000gm(p=0.013). No difference was seen for need of re-intubation/ventilation, but duration of ventilation was more on late group (p=0.043). Culture positive sepsis was found in 68% with higher association with late therapy (p=0.033). Hypotension was frequent complication with late intervention (p=0.029), whereas there was no difference for pulmonary hemorrhage or apnea. Conclusion: Early surfactant administration improved survival with minimal complications in RDS except for extremely premature/LBW babies

Neonatal Kasabach-Merritt Syndrome (KMS): case report

A 2days baby girl presented with congenital reddish-blue swelling over chest and abdomen with thrombocytopenia. The clinical, imagining and laboratory findings suggested the diagnosis of KMS. Oral steroid was started with initially needed platelet and FFP transfusions. Large thoracic hemangioma was non-amenable to surgical and radiological interventions. Vincristine was initiated after 2week trial of Prednisolone for persistent thrombocytopenia and non-regressing haemangioma. Over a week the lesion shrunk with improving platelet count. Vincristine was stopped after 4weeks in view of no further tumour shrinkage. The patient was discharged on steroid advised for 6-12 months and showed significant tumour regression at 3month

Maternal solubility test and high performance liquid chromatography of newborns in combination as a better neonatal screening protocol for sickle cell disease

Introduction: The incidence and prevalence of sickle cell disease in India is high and they are major health problem in India. Neonatal detection and prophylactic management can reduce morbidity and mortality in childhood. A study is therefore planned for analyzing maternal solubility test and HPLC of newborn as effective screening protocol. Material and Method: The infants born of solubility positive mothers were taken for hemoglobin analysis using Biorad Hemoglobin variant by high performance liquid chromatography (HPLC) at birth and the test was repeated at six months of age. Data were analyzed using appropriate statistical method. Results: A total of 100 mothers were positive on solubility test, their infants underwent Hb analysis by high performance liquid chromatography. 74 infants shows normal hemoglobin variants while 19 were heterozygous for Hbs (sickle cell trait) and 7 babies were homozygous for HbS at birth. On follow up at 6 month of age cases were reanalyzed by HPLC , 12 cases were lost in follow up, 7 cases who were heterozygous for sickle cell turned out to be homozygous for sickle cell, and of those with normal reports 7 cases were homozygous. Conclusion: Maternal solubility test and HPLC of newborn at birth is good screening protocol for sickle cell anemi

Prevalence of anemia & its association with various risk factors in slum dwelling adolescent girls of Raipur city

Introduction: Adolescent girls are at high risk for anemia and malnutrition, which can have serious consequences throughout the reproductive years of life in the form of high maternal mortality, low birth weight babies and perinatal mortality. Since much, less attention paid to this age group and there is paucity of data to represent the magnitude of this problem so we have conducted this study. Methods: This cross sectional observational study conducted in 385 adolescent girls in slums of Raipur city. Various socio-demographic factors, physical growth and nutritional status of the adolescent girls were assessed by anthropometric indices. Anemia detected by Sahli’s method. Data analyzed by appropriate statistical method, to find out the significance of association between various attributes. Result: Majority of girls were vegetarians (54.54%). 57.66% were undernourished. Anemia found in 61.03% cases out of which mild anemia was in 45.19% and moderate in 13.50%. A statistically significant association found between anemia and status of menarche, diet, nutritional status and education of mother. Conclusion: Majority of adolescent girls was suffering from mild anemia, which can be prevented by modification of diet, nutrition and other socio-demographic risk factors. This may require meticulous implementation of nutrition programmes and focus toward adolescent health

Study of Reproductive & Thyroid Hormones in adolescent with Sickle Cell Disease

Introduction: Sickle cell anaemia patients have been reported to suffer from endocrine dysfunctions which often have an influence on growth, development, and metabolism. Delayed somatic and sexual developments have been well described in patients with homozygous sickle cell disease. The present study focuses plasma levels of seven different endocrine hormones in individuals aged between 10-18 years, with a diagnosis of homozygous sickle cell disease. Material & methods: All study subjects were undergone for estimation of follicular stimulating hormone (FSH), Leuteinizing Hormone (LH), Testosterone, T3, T4 & TSH measured and value were analyse statistically. Observation: Study Patients with sickle cell disease showed LH, FSH Testosterone and Estradiol are significantly reduced in individual with homozygous sickle cell disease (SS) in comparison with control group suggest that the sickle cell gene abnormality has an adverse effect on endocrine functions. Conclusion: Routine screening for endocrine dysfunctions are advocated in all adolescent sickle cell disease patient