Cerebrospinal fluid C-reactive protein - A point of care test in the diagnosis of bacterial meningitis

Background: Bacterial meningitis is a significant life-threatening illness during infancy and childhood. Delay in distinguishing bacterial from viral or other aseptic meningoencephalitis may have irrevocable consequences. A typical case of pyogenic meningitis without prior antibiotics may not create any diagnostic problems, but prior treatment with inappropriate and inadequate antibiotics may cause sufficient alteration in biochemistry and cytology of cerebrospinal fluid (CSF), and organisms may not get isolated from blood or CSF culture. Objective: C-reactive protein in CSF (CSF-CRP) has been reported to be one of the most reliable and early indices to differentiate bacterial from non-bacterial meningitis. This study was undertaken to evaluate the diagnostic significance of CSF- CRP as an early indicator in the differentiation of bacterial from non-bacterial meningitis. Materials and Methods: This descriptive study was done in children in the age group of 1 month to 12 years who were admitted with history and clinical features suggestive of acute central nervous system infection. CSF was analyzed for macroscopic appearance, pleocytosis, proteins, and sugar content, Grams and Zieh

Comorbidities in children hospitalized with severe acute malnutrition

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. Conclusion: Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes

Socioeconomic determinants of breastfeeding practices in South India - A hospital-based cross-sectional study

Background: Breastfeeding is an unparalleled universally recommended intervention for the promotion of health and nutrition of children and reduction of mortality. In spite of the WHO recommendations and baby-friendly hospital initiative, breastfeeding practices are inappropriate due to maternal, infant, socioeconomic, and cultural factors. Objective: The objective of this study was to determine the socioeconomic factors associated with inappropriate breastfeeding practices. Secondary objective was to determine the knowledge level of mothers on ideal breastfeeding recommendations. Materials and Methods: This cross-sectional study was conducted in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. Mothers having children aged 7–60 months were included in the study. A sample size of one thousand was planned. After obtaining informed consent from mother, detailed feeding history including the timing of initiation of breastfeeding following childbirth, duration of exclusive breastfeeding, and age at which breastfeeding was discontinued was noted. Possible determinants considered were gender of the child, place of residence, maternal age, maternal education, maternal employment, number of children at home, type of family, whether mother was counseled during antenatal period, mode of delivery, and hospitalization in newborn period. Knowledge of mother on breastfeeding was probed and the response recorded. Univariate analysis followed by regression was performed to determine the significant factors. Results: 59% (95% confidence interval 55.9–62.1) of mothers initiated breastfeeding within 1 h of childbirth. 70.2% (95% CI - 67.3–73) exclusively breastfed their babies for 6 months and above. 43.6% (95% CI - 39.2–48.1) of mothers with children of age 25–60 months breastfed their babies up to 2 years and beyond. On univariate analysis, female gender, maternal employment, operative delivery, and hospitalization in the newborn period were identified as risk factors for inappropriate breastfeeding practices, which were confirmed by regression. Overall, only 26.6% (95% CI - 23.9–29.5) of mothers had appropriate knowledge about ideal breastfeeding recommendations. Conclusion: Female gender, maternal employment, operative delivery, and hospitalization in newborn period are significant independent risk factors for inappropriate breastfeeding practices. Only a quarter of mothers had adequate knowledge of breastfeeding recommendations

Comparison of various body fat indices in early and mid-adolescents of South India: School-based cross-sectional study

Background: The most important bottleneck in the management of obesity is a lack of a gold standard measuring tool. Although body mass index (BMI) is the most commonly used index to identify obesity, other indices such as waist circumference and skinfold thickness are more specific in measuring fatness. Objective: The objective of the study was to determine the agreement between BMI, waist circumference, and triceps skinfold thickness (TSFT) against body fat percentage calculated using 7-site skinfold thickness in South Indian adolescents. Methods: This cross-sectional study was performed in selected government-run schools in Chennai from May 2016 to October 2016. Schoolchildren of age 10–16 years without any medical illness which are known to cause discordant body proportions were included in the study. Sample size was fixed at 700. Date of birth, gender, and the anthropometric parameters, namely, height, weight, waist circumference, and skinfold thickness at triceps, chest, axilla, abdomen, thigh, subscapular, and suprailiac regions were measured by standard procedure and noted. Body fat percentage was calculated from 7-site skinfold thickness using Jackson-Pollock formula. Participants were classified as obese and non-obese based on BMI, waist circumference, TSFT, and body fat percentage using appropriate standards. Agreement between various indices was determined using Cohen’s kappa statistic. Results: BMI, waist circumference, and TSFT showed moderate agreement with body fat percentage calculated from 7-site skinfold measurement. BMI and TSFT showed substantial agreement (k=0.608 for BMI and k=648 for TSFT) with body fat percentage in girls and only fair agreement (k=0.366 for BMI and k=0.291 for TSFT) in boys. Waist circumference showed moderate agreement with body fat percentage in boys (k=0.523) and girls (k=0.575). Conclusion: BMI, waist circumference, and TSFT show moderate agreement with body fat percentage calculated from 7-site skinfold measurement in South Indian adolescents. Measurement of waist circumference is recommended to classify an adolescent as obese, especially boys