Profile of acute childhood poisoning at a tertiary care teaching hospital in North India

Objective: The objective of the study was to determine the profile and outcome of children under the age of 12 years admitted with acute poisoning at a tertiary care teaching hospital in Delhi. Materials and Methods: We retrospectively reviewed case files of all patients <12 years of age admitted with poisoning at pediatric emergency from January 2016 to December 2016. All cases with definite history of poisoning were included in the study. Exclusion criteria included chronic poisonings such as lead poisoning, food poisoning, foreign body ingestion, and homeopathic drug ingestion. Baseline characteristics of patients, type of poison, signs and symptoms of poisoning, investigations, treatment, and outcome were recorded from the case files and analyzed. Results: A total of 91 patients were presented with poisoning during the study period. Almost all cases (n=89, 97.8%) were accidental, only 2.2% (n=2) cases were suicidal, and none was homicidal. The mean age of presentation of these patients was 4.08±3.11 years with males outnumbering females (M: F=1.6:1). Corrosives (n=20, 21.9%), kerosene (n=17, 18.7%), prallethrin (n=11, 12.1%), and drugs (n=7, 7.7%) were the most frequently implicated agents. 11 patients (12.1%) were completely asymptomatic, while 30.7% (n=28) patients developed serious symptoms such as breathing difficulty, altered sensorium, seizures, abnormal speech, hematemesis, nasal bleeding, and hypotonia. Gastric lavage was done in 15 cases, three patients received activated charcoal, and three patients required intubation, and one patient required an emergency tracheostomy. One patient expired and rest all survived. Conclusion: The trends of pediatric poisoning noted in our center were different from those observed in other hospital based studies. Corrosives (particularly acids) being the most common agents. Prallethrin, kerosene, and drugs were other common agents

Rare association of celiac disease with congenital heart disease

Celiac disease (CD) is an autoimmune enteropathy caused by exposure to dietary gluten in genetically predisposed individuals. CD is a multisystem disease involving gastrointestinal, hepatobiliary, nervous, hematologic, and cardiovascular systems. Few associations of congenital heart disease have been reported with CD. We report a case of an 8-year-old female, who was presented to the hospital with severe anemia and undernutrition. She had severe pallor, clubbing, hepatomegaly, and a Grade Ш systolic ejection murmur. Echocardiography revealed a large ostium secundum type of atrial septal defect and patent ductus arteriosus. The increased levels of serum IgA anti-tissue transglutaminase (anti-TTG) antibody have arisen suspicion of CD, which was confirmed after the histopathological study of the duodenal biopsy. We are reporting this case to highlight the rare association of the CD with congenital heart disease

Scimitar syndrome - A rare cause of recurrent pneumonia

Scimitar syndrome is a congenital anomaly characterized by anomalous drainage of the right lung into inferior vena cava. This may be associated with other anomalies in the form of pulmonary hypoplasia, systemic arterial supply of right lung, and congenital heart diseases. We report an infant with recurrent pneumonia who turned out to be a case of scimitar syndrome on further workup. The patient was managed surgically by selective embolization of the artery from celiac trunk to sequestered lung. This case report highlights the fact that scimitar syndrome should be suspected in a patient with recurrent pneumonia with typical chest X-ray findings

Waardenburg syndrome-associated focal segmental glomerulosclerosis: A rare presentation

Waardenburg syndrome (WS) is characterized by auditory and pigmentary disorders with an incidence of 1:40,000. Renal involvement is rare in WS. A 10-year-old male, diagnosed as nephrotic syndrome at 4 years, was presented in relapse. A renal biopsy performed at 6 years revealed evidence of focal segmental glomerulosclerosis. The child had morphological findings which were suggestive of WS. Hence, a diagnosis of WS type 1, with frequently relapsing nephrotic syndrome, was made. The possible genetic basis of renal involvement in WS needs to be evaluated

Visual impairments in children with cerebral palsy

Background: Visual impairments are associated with cerebral palsy (CP). They enhance functional limitations in children with CP. Objective: The objective of the study was to determine the types of visual impairments in children with CP, and thus the importance of early evaluation and intervention to improve the quality of life. Materials and Methods: Children with CP (n=775) attending the child development clinic from 2012 to 2017 were included in the study. Thorough antenatal, natal, postnatal, and developmental history were recorded. Complete demographic data, anthropometry and general physical, and neurological examination findings were recorded. All patients were advised neuroimaging (computed tomography/magnetic resonance imaging) and hearing and ophthalmological assessment. Results: Of the 775 patients, 270 (34.8%) patients had squint (including convergent and divergent). Detailed fundoscopic and visual evoked potentials (VEP) examination was done in 382 patients. Non-apparent abnormalities (VEP and fundus changes) were seen in 121 patients (31.7%) among 382 tested. Of those 121 patients, VEP changes and fundus changes were seen in 62 and 41 patients, respectively. Refractive errors were detected in 25 patients. Of the total patients assessed for ophthalmological ailments, 129 (33.7%) patients were completely normal. Conclusion: Visual impairments are associated in large percentage of CP patients. Early evaluation and intervention are emphasized to improve the quality of life in these patients

The effect of nutritional status on the response to highly active antiretroviral therapy in human immunodeficiency virus-infected children at regional antiretroviral therapy centre in Northern India

Background: Effect of highly active antiretroviral therapy (HAART) on growth in children is well established but influence of prior nutritional status on the response to HAART is not well known. Objective: To determine the influence of prior nutritional status on the response to HAART in terms of growth and CD4 counts. Methods: It was a retrospective record review based study conducted at a regional ART centre at a tertiary care, teaching hospital in Northern India. Human immunodeficiency virus (HIV) positive children who were naïve to antiretroviral therapy and were initiated on treatment from January 2006 to December 2007 were included in this study. Age, weight, height and CD4 cell counts were recorded at the initiation of HAART and after 24 months of therapy. Data was analyzed using paired t-tests within the groups, Chi-square tests, and one-way analysis of variance. Results: Seventy-nine HIV positive children were included in the study. At baseline, 29% of children were normal weight, 27% moderately underweight and 44% severely underweight with mean CD4 counts 243.30±178.50, 282.95±173.69 and 215.11±85.71 respectively. After 24 months of HAART, mean CD4 cell counts as well as weight for age z scores increased significantly in all 3 groups with mean CD4 counts being 913.61±401.46, 931.24±363.54 and 775.31±424.43 respectively in the groups. There were no significant differences in CD4 counts in the groups both pre and post ART. Conclusion: Underlying malnutrition does not adversely affect growth and immunologic response (increase in CD4 count) to HAART in HIV-infected children

Immunogenicity of measles-rubella vaccine administered under India's Universal Immunization Programme in the context of measles–rubella elimination goal: A longitudinal study

Background & objectives: There is a paucity of data regarding immunogenicity of recently introduced measles–rubella (MR) vaccine in Indian children, in which the first dose is administered below one year of age. This study was undertaken to assess the immunogenicity against rubella and measles 4-6 wk after one and two doses of MR vaccine administered under India's Universal Immunization Programme (UIP). Methods: In this longitudinal study, 100 consecutive healthy infants (9-12 months) of either gender attending the immunization clinic of a tertiary care government hospital affiliated to a medical college of Delhi for the first dose of routine MR vaccination were enrolled. MR vaccine (0.5 ml, subcutaneous) was administered to the enrolled participants (1st dose at 9-12 months and 2nd dose at 15-24 months). On each follow up (4-6 wk post-vaccination), 2 ml of venous blood sample was collected to estimate the antibody titres against measles and rubella using quantitative ELISA kits. Seroprotection (>10 IU/ml for measles and >10 WHO U/ml for rubella) and antibody titres were evaluated after each dose. Results: The seroprotection rate against rubella was 97.5 and 100 per cent and against measles was 88.7 per cent and 100 per cent 4-6 wk after the first and second doses, respectively. The mean (standard deviation) titres against rubella and measles increased significantly (P<0.001) after the second dose in comparison to the levels after the first dose by about 100 per cent and 20 per cent, respectively. Interpretation & conclusions: MR vaccine administered below one year of age under the UIP resulted in seroprotection against rubella and measles in a large majority of children. Furthermore, its second dose resulted in seroprotection of all children. The current MR vaccination strategy of two doses, out of which the first is to be given to infants below one year of age, appears robust and justifiable among Indian children

Thrombocytopenia with bleeding manifestations in childhood malaria

Background: Thrombocytopenia is frequently found in malaria, but its prognostic value has not been addressed in children. Bleedingwith thrombocytopenia in malaria is not so common but can be a cause of mortality if left unattended. Objective: To study theoccurrence and severity of thrombocytopenia with bleeding manifestations in children with malaria. Materials and Methods: Thiscross-sectional study was conducted in a pediatric hospital of north India. All positive cases of malaria &lt;15 years of age admittedto the hospital between January 2008 and December 2013 were included in the study, and data were recorded on pre-designedpro forma. Patients were further assessed for thrombocytopenia and bleeding manifestations. Data were analyzed by Chi-squaretest and independent sample t-test using SPSS version 16. Results: Total 185 cases were included in the study with a median ageof presentation of 4 years. Plasmodium vivax was identified in 142 (77%) patients, whereas Plasmodium falciparum in 31 (17%)and mixed infection in 12 (6%) patients. Thrombocytopenia was observed in 79 (43%) cases, of which 35 (44%) cases had mild,30 (38%) cases moderate, and 14 (18%) cases had severe thrombocytopenia. Total 10 (5.4%) patients had bleeding manifestations,and all of these had thrombocytopenia. The most common bleeding manifestation was gastrointestinal bleeding presenting asmalena. No significant association was found between bleeding and severity of thrombocytopenia (p=0.527) or species of malaria(p=0.682). Furthermore, no significant association was found between severity of malaria and thrombocytopenia (p=0.365).Conclusion: Thrombocytopenia and bleeding were not significantly associated with the type of malaria. In an endemic area, ifa child presents with acute fever and thrombocytopenia with or without bleeding manifestation, diagnosis of malaria should bestrongly suspected

Sustainable Intensification of Cropping Systems under Conservation Agriculture Practices: Impact on Yield, Productivity and Profitability of Wheat

The continuous rice–wheat cropping system in South Asia has caused irreversible environmental damage, raising concerns about the long-term sustainability of the region’s agricultural systems. To address this issue, farm experiments were conducted for two successive years (2019–20 and 2020–21) to assess the impact of different cropping systems under conservation agriculture (CA) practices on the yield, productivity, and profitability of wheat. Results showed that the highest grain yield of wheat was observed in scenarios Sc6, Sc4, and Sc2, which involved full CA permanent-bed soybean (PB)–permanent-bed wheat (PB)–permanent-bed summer moong (PB), full CA permanent-bed maize (PB)–permanent-bed wheat (PB)–permanent-bed summer moong (PB), and partial CA puddled transplanted rice–Happy Seeder wheat–zero-till summer moong (ZT). Additionally, the highest irrigation water productivity (IWP), wheat grain macronutrient uptake, net return, and benefit–cost ratio (B:C ratio) were recorded under Sc6, full CA permanent-bed soybean (PB)–permanent-bed wheat (PB)–permanent-bed summer moong (PB) compared to farmers’ practice puddled transplanted rice (PTR)–conventional-till wheat–summer moong (Sc1) during both years. The system productivity also increased in scenarios Sc2, Sc4, and Sc6 (by 9.72%, 9.65%, and 14.14% in the first year and 10.68%, 14.14%, and 15.55% in the second year) compared to Sc1—farmers’ practice puddled transplanted rice (PTR)–conventional-till wheat–summer moong, Sc3—farmers’ practice fresh-bed maize (FB)–conventional-till wheat–summer moong, and Sc5–farmers’ practice fresh-bed soybean (FB)–conventional-till wheat (CT)–summer moong. The findings suggest that the conservation agriculture soybean–wheat–summer moong (Sc6) on permanent-bed cropping systems with inclusion legumes can be a potential option to enhance yield attributes, productivity, and profitability, as well as the sustainability of natural resources in the region while decreasing environmental footprints