Showing papers in "Indian Pediatrics in 2004"

Nutritional problems in urban slum children.

Abstract: Nutritional problems like protein energy malnutrition (PEM), anemia and vitamin A deficiency continue to plague a large proportion of Indian children. The diets and nutritional status of urban slum children in India is far away from being satisfactory. The nutritional status of slum children is worst amongst all urban groups and is even poorer than the rural average. Urban migration has not provided them salvation from poverty and undernutrition. Another distressing feature is the lack of any significant improvement over the years in this population. Most common causes of malnutrition include faulty infant feeding practices, impaired utilization of nutrients due to infections and parasites, inadequate food and health security, poor environmental conditions and lack of proper child care practices. High prevalence of malnutrition among young children is also due to lack of awareness and knowledge regarding their food requirements and absence of a responsible adult care giver. With increasing urban migration in the years ahead, the problem of malnutrition in urban slums will also acquire increasing dimension unless special efforts are initiated to mitigate the health and nutrition problems of the urban poor. Improving nutritional status of urban poor requires a more direct, more focused, and more integrated strategy.

IAP National Task Force for Childhood Prevention of Adult Diseases: Childhood Obesity.

Abstract: INDIAN PEDIATRICS 559 VOLUME 41JUNE 17, 2004 IAP National Task Force for Childhood Prevention of Adult Diseases: Childhood Obesity 6.1 Primary prevention of childhood obesity: Public Health Approach 6.2 Do interventions work ? 6.3 Strategies and Aims 6.4 Special strategies for target groups 6.5 Channels of intervention 7. Management of established obesity 7.1 Approach to assessment 7.2 Approach to therapy 7.3 Principles of therapy 7.4 Intensive therapy 8. Key Messages 9. References 10. Annexures

Pattern of pediatric dermatoses in a referral center in South India.

Abstract: This study was undertaken to determine the pattern of dermatoses in children in south India. All children <14 years presenting to us between May 2001 and June 2002 were recruited. A total of 2100 children (males -995; females- 1105) with 2144 dermatoses were recorded. Infections and infestations were the most common dermatoses (54.5%) followed by dermatitis and eczema (8.6%), pigmentary disorders (5.7%), insect bite reaction (5.27%), hair and nail disorders (5.2%), miliaria (4.1%), nutritional deficiency disorders (2.8%), urticaria (2.5%), genetic disorders (2.1%), psoriasis (1.4%), collagen vascular disorders (0.5%), hemangiomas (0.5%), drug eruptions (0.3%), pityriasis rosea (0.2%) and others (5.8%). Pyodermas were the most common dermatoses (47.13%) followed by scabies (30.6%) amongst infections and infestations. Atopic dermatitis was noticed only in 3 patients. Insect bite reactions (papular urticaria) (5.27%) and miliaria (4.1%) were attributed to the tropical weather conditions in this coastal area. Genetic disorders including ichthyosis and palmoplantar keratoderma contributed to 2.1% of cases and could be due to the high incidence of consanguinous marriages in this society.

Wheat grass juice reduces transfusion requirement in patients with thalassemia major: a pilot study

Abstract: Wheat grass juice is the juice extracted from the pulp of wheat grass and has been used as a general-purpose health tonic for several years. Several of our patients in the thalassemia unit began consuming wheat grass juice after anecdotal accounts of beneficial effects on transfusion requirements. These encouraging experiences prompted us to evaluate the effect of wheat grass juice on transfusion requirements in patients with transfusion dependent beta thalassemia. Families of patients raised the wheat grass at home in kitchen garden/pots. The patients consumed about 100 mL of wheat grass juice daily. Each patient acted as his own control. Observations recorded during the period of intake of wheat grass juice were compared with one-year period preceding it. Variables recorded were the interval between transfusions, pre-transfusion hemoglobin, amount of blood transfused and the body weight. A beneficial effect of wheat grass juice was defined as decrease in the requirement of packed red cells (measured as grams/Kg body weight/year) by 25% or more. 16 cases were analyzed. Blood transfusion requirement fell by >25% in 8 (50%) patients with a decrease of >40% documented in 3 of these. No perceptible adverse effects were recognized.

Pune low birth weight study--cognitive abilities and educational performance at twelve years.

Abstract: OBJECTIVE To assess the intelligence, visuo-motor perception, motor competence and school performance of children with birth weight less than 2000 grams, at the age of 12 years. DESIGN Prospective cohort study. SETTING Infants discharged from a Neonatal Special Care Unit of a referral hospital with birth weight less than 2000 g between 1987-89 and followed up in the High Risk Clinic. METHODS The children were assessed by the Weschler's Intelligence Scale, Bender Gestalt test for visuo-motor perception, Wide Range Achievement Test for specific learning disability, Draw-a-Person screening test for emotional problems and Movement Assessment Battery for motor competence. Academic achievement was also scrutinised. RESULTS One hundred and eighty children weighing less than 2000 grams at birth and ninety control children were assessed. The mean IQ of the study group was normal (89.5 +/- 16.9), though significantly lower than that of controls (97.2 +/- 14.1; p<0.05). Pre term SGA children had the lowest mean IQ (85.4 +/- 17.7). In the 78 VLBW children, there were 12 (15.4%) mentally retarded children as compared to only 3 (3.3%) amongst controls (p<0.001). There were only 3 (3.8%) 'bright' children among the VLBW group, as compared to 20 (22.2%) in the control group (p<0.001). Visuo-motor perception and motor competence of the study group was poor, and they had writing and mathematics learning disability, especially the preterm SGA and VLBW group. Academic achievement was poor and the incidence of borderline intelligence was 24.4%, which has increased from 13.4% at 6 years. CONCLUSIONS The intelligence and academic performance of the children weighing less than 2000 grams is significantly lower than that of controls, though within normal limits. They also have poor visuo-motor perception, motor incompetence, reading and mathematics learning disability. The preterm SGA and VLBW children had the poorest cognitive abilities.

Risk factors of threshold retinopathy of prematurity.

Abstract: OBJECTIVE To determine the risk factors which predispose to the development of threshold retinopathy of prematurity among patients of retinopathy of prematurity. METHODS The ROP clinic records of a 3 year period were retrospectively studied to identify babies with threshold ROP (T-ROP) and sub-threshold ROP (ST-ROP). Various antenatal and perinatal risk factors, neonatal morbidity and therapeutic interventions were compared between the 2 groups. RESULTS Of the total of 108 babies, 55 had T-ROP and 53 had ST-ROP. On univariate analysis, packed cell transfusions for anemia, double volume exchange transfusions (DVET), number of DVET, ventilation, gestational age

Adolescent sexual and reproductive health.

Abstract: This editorial focuses on adolescent sexual and reproductive health (ASRH) in south and southwest Asia. It discusses the focus of interventions with adolescents and states that it needs to shift from information given to building life skills which enhance ASRH.

Risk factors of substance use among street children from Delhi.

Abstract: Objective: To estimate the magnitude of and socio-demographic factors related to substance use among street children in Delhi. Design: Observational study. Methods: 115 male street children aged 6 to 16 years were interviewed at the time of their admission to an observation home. Results: More than half (57.4%) of the subjects had indulged in substance use before coming to the observation home. The agents consumed were nicotine (44.5%) inhalants (24.3%) alcohol (21.8%) and cannabis (26.4%). On application of multiple logistic regression maltreatment of the child by family members was found significant predictor of substance use in the study group. Conclusion: Substance use in street children is associated with unstable homes and maltreatment. (authors)

Prevalence and risk factors of asthma and wheeze in school-going children in Lucknow, North India.

Abstract: Objective: To assess the prevalence of asthma and wheeze and factors associated with it in children aged 6-7 and 13-14 years. Method: School based, prospective survey using self/ parental reporting of occurence of asthma or wheeze on pre-designed questionnaire. Results: Out of 112 schools, 17 and 15 schools were randomly selected for recruitment of subjects in age group 6-7 and 13-14 years, respectively. Prevalence of asthma and wheeze reported were 2.3% and 6.2%, respectively, in age group 6-7 years and 3.3% and 7.8%, respectively, in age group 13-14 years. On the basis of adjusted odds ratio, risk factors for wheeze /asthma were tertiary education of mother, antibiotic use in the first year of life, eating pasta or fast-food or meat once or more/week and exercise once or more/week while the protective factors were intake of vegetables once or more and fruits thrice or more per week. In univariate analysis, breastfeeding was also found to be protective. Conclusion: Promotion of rational use of antibiotic in first year of life, avoidance of fast food and promotion of breastfeeding and intake of fruits and vegetables may reduce the risk of asthma/wheeze and should be encouraged.

Early childhood development in deprived urban settlements.

Abstract: Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. Examples from countries, across the globe provide evidence of improved early child development, made possible through integrated slum improvement programs, are few in numbers. The observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, the presence of risk factors for developmental delay like low birth weight, birth asphyxia, coupled with poor environment of home and alternate child care services, highlights the need for simple cost effective community model for promoting early child development. This review on early child development focuses on the developmental status of children in the deprived urban settlements, who are yet to be on the priority list of Governments and international agencies working for the welfare of children, the contributory nature-nurture factors and replicable working models like infant stimulation, early detection of developmental delay in infancy itself, developmental screening of toddlers, skill assessment for preschool children, school readiness programs, identification of mental sub-normality and primary education enhancement program for primary school children. Further, the review probes feasible intervention strategies through community owned early child care and development facilities, utilizing existing programs like ICDS, Urban Basic Services and by initiating services like Development Friendly Well Baby Clinics, Community Extension services, Child Development Referral Units at district hospitals and involving trained manpower like anganwadi/creche workers, public health nurses and developmental therapists. With the decentralization process the local self-government at municipalities and city corporations are financially equipped to be the prime movers to initiate, monitor and promote early child development programs, to emerge as a part and parcel of community owned sustainable development process.

Is C-reactive protein level useful in differentiating infected from uninfected neonates among those at risk of infection?

Abstract: Objective: To document effects of intrapartum risk factors for early onset sepsis (EOS) on CRP levels in neonates and to assess the suitability of this test in diagnosing EOS. Design: Cohort study. Setting: Labour and post natal wards in a tertiary level teaching hospital in India. Subjects: 250 neonates at risk of developing infection. Methods: CRP levels in cord blood and neonatal blood at 24 hrs were estimated using commercial kits. Babies were observed for signs of sepsis for at least 48 hours. Results: Seven (2.8%) neonates had elevated CRP levels in the cord blood. At 24 hours, 102 (40.8%) babies had elevated levels. Elevated cord CRP levels was significantly associated with rupture of membranes for 24 hours (p =0.04), labour more than 12 hours (p = 0.002), and maternal fever (p = 0.01). At 24 hours, elevated CRP levels were associated with primiparity (p= 0.006), more than three vaginal examinations after membrane rupture (p=0.02), meconium staining of amniotic fluid (p =0.02) and amnioinfusion (p =0.02). Ten (4%) babies developed EOS. The negative predictive value for elevated CRP levels at 24 h was 99%. Conclusion: Several intrapartum risk factors for EOS can cause elevation in CRP levels. However, this test may be useful in excluding infection.

Adolescent health determinants for pregnancy and child health outcomes among the urban poor.

Abstract: Adolescents among the urban and rural poor have a high incidence of chronic energy deficiency (CED) and anemia, more so in girls than in boys. Adolescent pregnancies (15-19 years) contribute to 19% of total fertility in India and record the highest maternal mortality rates. Besides maternal age, lack of education, low socio-economic status, maternal undernutrition and limited access to maternal health services are important determinants of poor pregnancy outcomes. Low birth weight is the major adverse outcome for the infant and an important determinant of increased child mortality. There is a lack of data for long term follow up of infants of adolescent mothers versus mothers 20 years and above, and more specifically, in the urban poor setting, an emerging concern.

Comparative efficacy of desferrioxamine, deferiprone and in combination on iron chelation in thalassemic children.

Abstract: Objective: Ascertainment of an appropriate strategy of iron chelation for multi-transfused thalassemic children in developing countries. Design: Prospective study from May 2000 to April 2001. Setting: Urban tertiary care center. Methods: Thirty thalassemic children having received more than 20 blood transfusions and a serum ferritin greater than 1500 ng/ml were enrolled and randomized into three groups. Group I received desferrioxamine (DFX) at a dose of 40 mg/kg subcutaneously, 5 days/week. Children in group II received oral deferiprone (L I ) at a dose of 75 mg/kg/day daily and group III received a combination of daily L I at a dose of 75 mg/kg/day and DFX at a dose of 40 mg/kg/day two times per week. The assessment of chelation was done by 24-hr urinary iron excretion (UIE) and measurement of serum ferritin levels at start and after 6 months of follow up. Statistical difference of serum ferritin levels between the three groups was assessed by applying analysis of variance. Analysis of covariance was applied to find out the urinary iron excretion keeping serum ferritin values same in each groups. Results: Ferritin levels after 6 months of intervention were maximally decreased in group I. There was a significant difference between groups I and II however, no difference was noted between groups I and group III. There was no statistically significant difference in mean urinary iron excretion by keeping the initial serum ferritin levels equal though it was found to be more in group III as compared to other groups. Conclusions; DFX is the most effective chelating drug in iron overloaded multi-transfused thalassemic patients. In view of cost and unacceptability of daily DFX injections, combination therapy is an effective method of chelation thus increasing the compliance and cost effectiveness. Deferiprone (L I ) alone is not an effective mode of chelation when used for a short period.

Category based treatment of tuberculosis in children.

Abstract: Background Childhood tuberculosis is treated with multiple regimens for different clinical manifestations. World Health Organization has suggested a category-based treatment of tuberculosis that focuses on adult type of illness. To include children as DOTS beneficiaries, there is a need to assess the feasibility of classification and treatment of various types of childhood tuberculosis in different categories. Methods The study was conducted in the Pediatric Tuberculosis (TB) Clinic of a tertiary care hospital in North India. All children registered in the TB clinic were classified in four categories, similar to the categorization in World Health Organization's guidelines for treatment of tuberculosis in adults. All children with freshly diagnosed serious form of tuberculosis were included in category I. Category II included patients who had treatment failure, had interrupted treatment, relapse cases and those who were suspected to have drug resistant tuberculosis. Patients with primary pulmonary complex (PPC), single lymph node tuberculosis, minimal pleural effusion and isolated skin tuberculosis were included in category III. Category IV included patients who did not improve or deteriorated despite administration of 5 drugs (as per Category II) for at least 2 months. Results A total of 459 patients were started on antituberculosis drugs and were available for analysis. Pulmonary tuberculosis was the commonest followed by lymph node tuberculosis. Identification of AFB was possible only in 52 (11 percent) of the patients and was more commonly seen in lymph node tuberculosis. The mean age of the children was 93 months and sex distribution was almost equal. 323 patients were in category I, 12 in category II, 120 in category III and 4 in category IV. 365 (80 percent) children completed the treatment. Of these, 302 (82.7 percent) were cured with the primary regimen assigned to them in the beginning, 54 (14.8 percent) required extension of treatment for 3 months and 9 (2.5 percent) patients required change in the treatment regimen. Side effect in form of hepatotoxicity was observed in 12 (2.6 percent) patients and was significantly more in patients who were getting category IV treatment. Conclusion It is feasible to classify and manage various types of tuberculosis in children in different categories similar to WHO guidelines for adult tuberculosis.

Trends in neonatal septicemia: emergence of non-albicans Candida.

Abstract: In a prospective analysis, blood from 660 neonates admitted to neonatal Intensive Care Unit (NICU) of a teaching hospital with clinical suspicion of septicemia was cultured to look for etiological agents with particular reference to role of Candida species. Blood culture specimens from two different sites at same time were obtained to rule out possibility of a Candida isolate being a mere contaminant. Due to technical difficulties, this was possible in only 338 neonates (Group I); from remaining 322 neonates only single specimen was available (Group II). Candida was isolated from total 90 neonates (isolation rate 13.6%) and it was the single most common isolate. Majority were non-albicans Candida (germ tube test negative - 76/90). In group I, Candida was isolated from 66 neonates, of these 49 grew Candida in both specimens (significant candidemia). 44 records were available for analysis. Low birth weight was found in 73.3%. Crude mortality was 52.6%. A peak in isolation rate of Candida was noted (isolation rate 27%, p<0.05) in month of February. In Group I, 49 of the total 66 (74.2%) isolates of Candida were significant, suggesting that three in every four Candida isolated from blood can be significant. Non-albicans Candida are emerging as important pathogens for neonatal septicemia.

Clinical and microbiological profile of nosocomial infections in the pediatric intensive care unit (PICU).

Abstract: This study was conducted in PICU of a teaching hospital to estimate the incidence of nosocomial infections establish the clinical and bacteriological profile and identify probable exogenous source from the environment and personnel. 95 suspected cases of nosocomial infections were studied prospectively identified as per the guidelines laid down by CDC. The rate of nosocomial infections was 27.3% with an incidence of 16.2 per 100 patient days. The incidence of urinary respiratory and intravascular catheter related infections was 56.52% 34.78% 10.52% respectively. Klebsiella (33.33%) was the most common isolate with maximum sensitivity to amikacin. During the study an outbreak of MRSA nosocomial infection was encountered and the source was traced to portable suction pump. The risk of nosocomial infection was directly related to the duration of stay in the PICU and duration of placement of indwelling catheters /tubes. (authors)

Slow versus fast enteral feed advancement in very low birth weight infants: a randomized control trial.

Abstract: Objective: To evaluate the tolerance of rapid advancement of enteral feeds in VLBW babies. Setting: Tertiary teaching hospital. Design: Randomized controlled trial. Methods: All stable neonates with birth weight <1250 grams were included in the study. The primary outcome variable was the time taken to achieve full enteral feeds (defined as 180 ml/kg/day). The secondary outcome variables were incidence of Necrotizing enterocolitis (NNEC) and incidence of apnea. At 48 hours the infants were randomized into the slow advancement group (enteral feeds advanced by increments of 15 ml/kg/day) or fast advancement group (enteral feeds advanced by increments of 30 ml/kg/day). The monitoring during feeding included daily weight record two hourly abdominal girth charting gastric aspirates apnea time taken to reach full enteral feedings and for NNEC. Results: There were 53 infants who were enrolled for the study ( 27 in the fast advancement group and 26 in the slow advancement group). In the fast advancement group 20 (74%) completed the trial; whereas 14 (53.8%) in the slow advancement group completed the study. The two groups were comparable for birth weights gestational age sex intrauterine growth status Apgar and CRIB scores. The infants in the fast group reached full enteral intake of 180ml/kg/day significantly earlier (10 ± 1.8 days) than in the slow group (14.8 ± 1.5 days). The two groups were comparable for episodes of feed intolerance apnea NNEC. Infants in the fast group regained birth weight significantly earlier (median 18 days) than in the slow advancement group (median 23 days). Conclusions: Stable VLBW neonates can tolerate rapid advancements of enteral feeding without increased risk of adverse effects. (authors)

Permanent dentition in Delhi boys of age 5-14 years.

Abstract: Eruption pattern of permanent teeth in Delhi boys was studied in 1800 well nourished children age 5-14 years. Relationship of height, weight and sexual maturity with eruption of teeth was calculated. Earliest teeth to appear were lower first molar (5.64 years) followed by lower central incisors (6.02 years), The sequence of eruption in maxilla was first molar, incisors-central then lateral, first premolar, canine, second premolar and second molar. In mandible eruption pattern canine preceded first premolar. Eruption of teeth was significantly positively related to height, weight and sexual maturity.

Amitraz poisoning: clinical and laboratory findings.

Abstract: Amitraz is an insecticide/acaricide of formamidine pesticides used worldwide to control ectoparasites in animals. Amitraz poisoning is a rare disorder characterized by central nervous system (CNS) and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia,nausea and vomiting. Poisoning may occur either by oral inhalation and dermal route. In this study, we present seven pediatric patients with amitraz poisoning. The initial symptoms were unconsciousness, dizziness and vomiting; and emerged within 30-150 minutes. The length of stay in the intensive care unit (ICU) was between 18-62 hours.

Vitamin D level in slum children of Delhi.

Abstract: INDIAN PEDIATRICS 1076 VOLUME 41OCTOBER 17, 2004 Sharma and Virmani(1) have looked at X-ray and blood biochemistry (serum calcium, phosphorus and Alkaline phos-phatase levels) in 100 infants and children with clinical rickets in Delhi and found that 35% children had low calcium and 35.5% children had raised alkaline phosphatase. However, to diagnose vitamin D deficiency with rickets, it is best that vitamin D metabolites are measured. 25 Hydroxy-cholecalciferol (25 (OH) D) is the most reliable measure of an individual’s vitamin D status(2). We have recently conducted a study looking at the 25 (OH) D levels in slum children from three areas in Delhi and found evidence of widespread vitamin D deficiency. This study was funded by Department of Science and Technology of the Government of India.

Consensus Statement of IAP National Task Force: status report on management of acute diarrhea.

Abstract: The Indian Academy of Pediatrics Committee For Framing Guidelines On The Management Of Diarrhea In Children (members listed in Annexure 1) convened a meeting at the All India Institute of Medical Sciences, New Delhi, to revise the guidelines for management of diarrhea in children. The focus of this review was oral rehydration solutions, zinc and probiotics in acute diarrhea, drug treatment of dysentery, and management of diarrhea in the young infant and severely malnourished subjects. The

IAP National Task Force for Childhood Prevention of Adult Diseases: insulin resistance and Type 2 diabetes mellitus in childhood.

Abstract: Type 2 diabetes mellitus (DM) has traditionally been considered a disease of adults. However, in the last 2 decades, it is increasingly being reported in children and adolescents. Obesity is a strong correlate, and the increasing prevalence of obesity and poor physical activity is precipitating type 2 DM at younger ages in the ethnic groups at risk. Indians and other South Asians are among the ethnic groups particularly prone to insulin resistance and type 2 DM, the other racial groups being some American Indian tribes like the Pima Indians, Mexican Americans,Pacific Islanders and African Americans,among others. The WHO has predicted that India will have the greatest number of diabetic individuals in the world by the year 2025. Type 2 DM starting during adolescence puts the individual at risk for major morbidity and even mortality right during the productive years of life. The microvascular complications of DM (nephropathy, retinopathy, neuropathy) are brought on at an early age. In addition, type 2 DM and obesity are two components of a metabolic syndrome of insulin resistance, the other features of which include hypertension, dyslipidemia and hypercoagulability of blood. All these conditions together increase the risk for cardiovascular and cerebrovascular mortality and morbidity (i.e., myocardial infarction and stroke). The resulting economic burden will be enormous. Type 2 DM and the insulin resistance syndrome are to a large extent preventable. Adoption of a healthy eating and physical activity pattern has resulted in decreasing the development of DM in a few recent studies from various parts of the world. A concerted,multi-pronged effort is needed, involving the general public, pediatricians and general physicians, teachers and schools, the media,the government and professional medical bodies, to generate a momentum towards the goal of prevention of type 2 DM and the insulin resistance syndrome in the young population of India.

Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections

Abstract: Objectives To determine clinical predictors of hypoxemia in children with acute lower respiratory tract infection (ALRI). Design Cross-sectional study. Setting Emergency department of All India Institute of Medical Sciences, a tertiary care hospital. Subjects 109 under five children, with ALRI. Methods Clinical symptoms and signs were recorded. Oxygen saturation was determined by a pulse oximeter. Hypoxemia was defined as oxygen saturation less than 90%. The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated. Results Twenty-eight (25.7%) children were hypoxemic. No symptoms were statistically associated with hypoxemia. Tachypnea, suprasternal indrawing, intercostal indrawing, lower chest indrawing, cyanosis, crepitations, and rhonchi were statistically significantly associated with hypoxemia. A simple model using the presence of rapid breathing (> or =80/min in children or =70/min in >3-12 m and > or =60/min in >12 m) or lower chest indrawing had a sensitivity of 78.5% and specificity of 66.7% for detecting hypoxemia. No individual clinical symptom/sign or a combination had both sufficient sensitivity and specificity to identify hypoxemia. Conclusion None of the clinical features either alone or in combination have desirable sensitivity and specificity to predict hypoxemia in children with acute lower respiratory tract infection.

Rotavirus infection in children with acute diarrhea as detected by latex agglutination ELISA and polyacrylamide gel electrophoresis.

Abstract: We examined prospectively, stool specimens from 135 children, 0 to 3 years old, referred for fever, abdominal pain, vomiting and/or acute diarrhea. Rotavirus antigens were detected from fecal samples by latex agglutination (LA), ELISA and polyacrylamide gel electrophoresis (PAGE). Rotavirus antigen positivity by Latex, ELISA and PAGE were 15, 55%, 12.59% and 11.85%, respectively. With PAGE test as reference, the sensitivity and specificity of LA and ELISA tests was 93.75%, 94.96% and 100%, 99.16%, respectively, The positivity ratio between 13-24 months group was meaningful with all tests (P = 0.042 for LA; P = 0.05 for ELISA; P = 0.031 for PAGE). ELISA and LA use found to be as sensitive and specific as PAGE in the diagnosis of rotavirus diarrhea.

Comparison of axillary temperature with rectal or oral temperature and determination of optimum placement time in children.

Abstract: The present study was done to compare axillary temperature (AT) with rectal temperature (RT) in 100 infants and with oral temperature (OT) in 100 children agd 6 to 12 years and also to find out the optimum placement time of the mercury thermometer at the above sites. Simultaneous AT and RT recording was done in infants while sequential AT and OT recording was done in older children by different investigators using calibrated Hick thermometers. The placement time recorded was when 3 consecutive readings at one minute interval remained unchanged. Significant correlation was observed between RT and AT (r=0.95, p <0.01) and between OT & AT (r = 0.97, p 0 <0.01). Equations were derived to calculate RT & AT from AT. The mean placement time for RT, AT and OT was 2.3 minutes, 4.8 minutes and 3.1 minutes respectively. The study showed a high degree of correlation between OT or RT and AT.

Blood zinc levels in children hospitalized with severe pneumonia: a case control study.

Abstract: A case control study was conducted in a referral and teaching hospital in North India on children aged 2 months to 5 years, to compare blood zinc levels in 50 cases of severe pneumonia and 50 age,sex and nutritional status matched controls. Mean blood Zinc levels in cases and controls was 376.1 ug/dL + 225.73 and 538.52 microg/dL +/- 228.0 respectively ( P value 0.0003). In logistic regression model severe pneumonia was associated with lower blood zinc level, use of biomass fuel and isolation of H. Influenzae from nasopharyngeal swab. Cotrimoxazole resistant S. pneumoniae were isolated from 95% of cases and 41.2 % of controls (P = 0. 0004). Therefore, the role of zinc in treatment of severe pneumonia should be investigated.

Spectrum of atypical celiac disease in North Indian children.

Abstract: Atypical celiac disease (ACD) presenting in childhood has rarely been documented from India. The present retrospective study analyzed features of atypical celiac disease over a 5-year period. Patients were diagnosed to have Celiac Disease (CD) as per the standard ESPGHAN criteria. The biochemical and hematological parameters of the cohort of children presenting with atypical features (ACD) were compared with children presenting as typical diarrheal CD. Twelve children were diagnosed to have CD. Seven of them presented with ACD. The two groups did not differ significantly in their age of presentation, hematological and biochemical profile. Osteoporosis as documented on bone mineral densitometry was present in all 6 patients of ACD in whom BMD was done. Short stature (4) and refractory iron deficiency anaemia (3) was the commonest modes of presentation of ACD. Occurrence of these conditions either singly or in combination warrants exclusion of celiac disease in children.

Comparison of pediatric emergency patients in a tertiary care hospital vs a community hospital.

Abstract: This study was conducted to compare the profile of patients attending the pediatric emergency services of a tertiary care teaching and referral hospital, Chandigarh, and a community level hospital in Ambala district, Haryana. Records of children (

Long-term antibody response and immunologic memory in children immunized with hepatitis B vaccine at birth.

Abstract: Four hundred and fifty three healthy children immunized with a course of hepatitis B vaccine beginning at birth were tested at 10-11 years of age for persistence of anti-hepatitis B-S antigen antibody (anti-HBs); and responses of children without protective antibody to different doses of hepatitis B vaccine booster were evaluated. Although nearly 42% of them were not seroprotected but most of boosted subjects (87.3%) retained robust immunologic memory and rapidly retained a protective anti-HBs antibody titer of at least 10 I/L after booster vaccination. (authors)