Showing papers in "Indian Pediatrics in 2007"

IAP growth monitoring guidelines for children from birth to 18 years.

Abstract: Growth Monitoring is a screening tool to diagnose nutritional, chronic systemic and endocrine disease at an early stage. It has been suggested that growth monitoring has the potential for significant impact on mortality even in the absence of nutrition supplementation or education(1). Experience in Tamilnadu, Maharashtra and other states in India indicates that individual growth monitoring of children is both feasible and extremely useful(2-4).

Sytematic review and meta-analysis of prevalence of hepatitis B in India.

Abstract: The objective was to evaluate the point prevalence of Hepatitis B in India. The design used was a meta-analysis of data on point prevalence from different parts of the country. Searches were made in Medline Cochrane Library and Best bets and previous reviews. A limited hand search of cross references was also done. Finally a consultation with experts was held to enlarge the references base. Studies reporting prevalence of HBsAg were selected. Data from high risk groups were excluded. 54 papers reporting data on 61 populations were identified. The true prevalence for each study was calculated from the reported prevalence using the specificity and sensitivity of the test employed. The true prevalence in non-tribal populations is 2.4% (95% CI: 2.2% -2.7%). True prevalence among tribal populations is 15.9 % (CI: 11.4% -20.4%). These figures may be useful in estimation of the burden of the disease in the country and for projecting the cost-benefits of immunization. (authors)

Idiopathic pulmonary hemosiderosis: clinical profile and follow up of 26 children.

Abstract: Objectives To describe the clinical details and follow up of children with idiopathic pulmonary hemosiderosis Design Retrospective case series Setting Pediatric chest clinic of a tertiary care hospital Subjects Children diagnosed as suffering from idiopathic pulmonary hemosiderosis (IPH) Methods Charts of patients diagnosed as IPH were reviewed for clinical features and treatment regimen Diagnosis was based on presence of iron deficiency anemia, chest radiography and demonstration of hemosiderin laden macrophages in bronchoalveolar lavage (BAL), gastric aspirate, or sputum Treatment consisted of oral prednisolone, hydroxychloroquine (HCQ) and inhaled corticosteroids (ICS) Results The common clinical features in 26 children with IPH (mean age 75 months) included: cough, breathlessness, fever, hemoptysis and wheezing in 26 (100%), 22 (85%), 19 (73%),15 (58%) and 14 (54%) children, respectively Clubbing, hepatomegaly and splenomegaly was seen in 16 (62%), 15 (58%) and 10 (38%) children, respectively Hemosiderin laden macrophages were documented in BAL and gastric aspirate in 92% and 30% patients, respectively Symptoms did not recur in 17 patients who received prednisolone and HCQ initially 5 patients had recurrence of symptoms and required short courses of oral prednisolone, 4 patients required frequent courses of prednisolone and were started on azathioprine Older age, longer duration of illness, history of hemoptysis and jaundice were associated with poor response Conclusion Treatment with prednisolone and hydroxychloroquine followed by inhaled corticosteroids may improve survival in children with IPH

Nutritional status of affluent Indian school children: what and how much do we know?

Abstract: OBJECTIVE This paper reviews available literature on nutritional status of Indian school children 6-18 years from middle and high socio economic status (MHSES). METHODS Literature search was conducted using Medline literature database search, followed by review of full length journal papers and unpublished materials such as research reports. RESULTS Studies showed that anemia prevalence (hemoglobin concentration <120 g/L) ranged from 19 to 88% across five different cities in India. Other micronutrient deficiencies including, folate, riboflavin, niacin, vitamin C, vitamin A, and vitamin B12 were also present based on biochemical parameters in one study and clinical signs of deficiency in three other studies. Overweight and obesity were prevalent among 8.5-29.0% and 1.5-7.4% respectively among school children, as indicated by 11 studies. Predominant components in children's diet were cereals and pulses, followed by milk and milk products; the fruits and vegetables component was comparatively lower. CONCLUSION Nutritional status of MHSES children in India needs attention especially with respect to the high prevalence of anemia, overweight and obesity. There are indications that micronutrient deficiencies exist, but sufficient data are lacking, in particular biochemical data. A current estimate, using well designed methodologies, of prevalence of micronutrient deficiencies and information on the etiology of anemia among children of MHSES groups would be valuable to help understand the nutritional status and extent of micronutrient malnutrition.

IAP Guidelines 2006 on management of acute diarrhea.

Abstract: The Indian Academy of Pediatrics National Task Force for framing Guidelines on the Management of Diarrhea in children convened a meeting at the All India Institute of Medical Sciences under the chairmanship of Professor MK Bhan in August 2003, 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. Several important developments had been made in the field of management of diarrhea in children as a result of research done in India and globally. The objective of this meeting was to take follow-up steps to ensure that the benefits of new knowledge reach affected children in India and at the same time ensure that new products are not inappropriately used.

Bullying in schools: prevalence and short-term impact.

Abstract: OBJECTIVES: To estimate the prevalence of bullying in school children and to examine its association with common symptoms in childhood. DESIGN: Prospective survey using a pre-tested questionnaire for conducting a semi structured health interview. SETTING: Randomly selected Public and private schools in a rural area. SUBJECTS: Children aged 8-12 years studying in three schools and their parents. RESULTS: Bullying was reported by 157 (31.4%) of the 500 children interviewed. There was no significant difference in the prevalence of bullying amongst boys and girls in co-education schools. However, it was significantly low in schools enrolling girls alone. Teasing and keeping names were the commonest forms noticed. Causing physical hurt was reported bv 25 (16%) students. Only 24 (24%) parents were aware that their children were being bullied. Feeling sad, preferring to stay alone and frequent tearing of clothes were almost exclusively noted in bullied children and bullied children were more likely to report symptoms such as school phobia, vomiting and sleep disturbances. CONCLUSION: Bullying is a common phenomenon amongst school going children. Frequent bullying is associated with certain symptoms and school absenteeism. Healthcare professionals. should be aware of this phenomenon so that they can diagnose the underlying cause when these symptoms are reported and plan for appropriate interventions. Language: en

Bone mineral density in beta-thalassemia major and intermedia.

Abstract: OBJECTIVE This study was conducted to assess bone mineral density (BMD) and bone mineral content (BMC) in patients with thalassemia major and intermedia, and to correlate them with biochemical and hematological profile. DESIGN 106 thalassemic patients (49 major and 57 intermedia) were scanned by dual energy xray absorptiometry technique for BMD and BMC at lumbar spine and femoral neck. The effects of sex, transfusion/chelation program as well as hemoglobin, calcium, phosphorus, alkaline phosphatase and serum ferritin level were also evaluated on BMD and BMC. RESULTS Patients with thalassemia major and intermedia, younger than 20 yr, showed lower BMD and BMC in the lumbar region (p < 0.05). Both parameters correlated significantly with hemoglobin level; other biochemical and hematological parameters did not influence BMD and BMC values. CONCLUSION Bone marrow density is a good index of bone status in patients with Thalassemia and should be done in these patients annually.

Subclinical hypovitaminosis D among exclusively breastfed young infants.

Abstract: The objective was to determine Vitamin D status of mother-newborn diads at birth and of their exclusively breastfed (EBF) infants at 3 months. The design used was a longitudinal study. The methods used were exclusively breastfed infants born at term with birth weight greater than 2.5 kg to normal healthy mothers followed till 3 months. Serum calcium phosphorous heat labile alkaline phosphatase (HLAP) and 25(OH)D estimated in 42 mother / cord blood diads and in 35 (EBF) infants followed up at 3 months. Twenty five (OH)D less than 15 ng/mL was considered low and 15 to 25 ng/mL low to normal. Ca P HLAP were significantly higher in cord blood (P less than 0.001) but mean 25 (OH)D 19.36 ng/mL was comparable to maternal level of 22.9 ng/mL (r = 0.82 P less than 0.001). At 3 months only HLAP was significantly higher compared to cord blood. Higher 25 (OH)D at 3 months correlated with higher 25 (OH)D values in cord blood (r = +0.616 P less than 0.001) as well as higher antenatal maternal levels (r = + 0.552 P less than 0.001). Serum 25 (OH)D values less than 25 ng/mL was observed in 50% mothers 62% cord blood specimens and 80% infants at 3 months. Subnormal maternal vitamin D status is associated with vitamin D deficiency in newborns and persists in exclusively breastfed infants. (authors)

Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: a randomized controlled trial.

Abstract: The objective was to study the effects of human milk fortification on short term growth and biochemical parameters in preterm very low birth weight (VLBW) appropriate for gestation (AGA) and small for gestation (SGA) babies. Design: Prospective randomized controlled trial. Setting: Level III neonatal unit Subjects: Preterm infants weighing = 1500 grams and =34 weeks of gestation born between March 2001 to June 2002. Babies (n =166) were randomized in two groups either to get fortified human milk or exclusive human milk along with mineral and vitamin supplementation when feed volume reached 150 mL/Kg/day. Fortification was done with a powdered fortifier added in expressed breast milk and continued till the baby reached 2 Kg or full breast feeds. Primary outcome measures were Short-term growth (daily weight length and head circumference (HC) weekly) till discharge or 2 Kg. Fortification (n = 85 birth weight 1202 g gestation 30.8 wk) resulted in better growth in preterm VLBW babies as compared to control group (n=81 birth weight 1259 g gestation 31.3 wk). Weight gain (15.1 and 12.9 g/kg/d P <0.001) length (1.04 and 0.86 cm/week P = 0.017) and HC (0.83 and 0.75cm/week P<0.001) increased significantly in fortified group. SGA babies showed significant improvements in weight (16g/Kg/d and 12.9g/kg/d P = 0.002) and length (1.09 cm/week and 0.92 cm/week P = 0.042) in fortified group (n = 38) as compared to control group (n = 29). In AGA subgroup there was significant increase (P = 0.006) in length (1 cm vs 0.82 cm) in fortified group but no difference in weight (P = 0.12) or HC (P=0.054) in fortified (n=47) vs control (n=52) group. Biochemical parameters were comparable however feed intolerance was more in control group. Preterm VLBW babies showed better growth with human milk fortification. The effect is significant in SGA (weight and length) rather than AGA (only length) babies. (authors)

Low dose 'Sprinkles'-- an innovative approach to treat iron deficiency anemia in infants and young children.

Abstract: Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in India Sprinkles is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia Objective We aimed to determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops Setting Twenty two villages of Vadu Rural Health Program, KEM Hospital, Pune Design Double blind clustered randomized community-based trial Subjects Children (n=432) aged 6 to 18 mo age with Hb between 70 to 100 g/L were enrolled Methods Selected villages were randomized into 5 groups: Sprinkles 125, 20 or 30 mg ferrous fumarate, Sprinkles 20 mg micronized ferric pyrophosphate or drops 20 mg ferrous glycine sulphate (DROPS) for 8 weeks Household socio-demographic information was collected at baseline Side effects and compliance were monitored through weekly visits Hemoglobin was estimated at baseline, 3 and 8 weeks Ferritin was assessed at baseline and 8 weeks Results Baseline characteristics were similar across all groups Hemoglobin increased significantly (P 005) Conclusions Sprinkles 125 mg FF dose is as efficacious as higher doses of iron in Sprinkles or DROPS in increasing hemoglobin Sprinkles FF 125 mg is recommended as it has fewer reported side effects and better compliance compared to DROPS

Helicobacter pylori in children: An Indian perspective.

Abstract: Helicobacter pylori is causally associated with peptic ulcer disease and gastric carcinoma Typically children get infected with this organism during the first decade of life but diseases, associated with H pylori, are seen mainly in adults In India, almost 80% of population is infected with H pylori and most of them by 10 years of age Hence, it is important for a pediatrician to know when to suspect this infection, how to investigate and how to treat it Extensive electronic (PubMed) literature search was done for this review and literature (randomized controlled trials, clinical trials, meta-analysis, practice guidelines) related to H pylori in children were reviewed Special emphasis was given to Indian studies From this review we can conclude that H pylori infection is very common in Indian children especially in the low socioeconomic status but most infected children remain asymptomatic through out their childhood and about 15% develop peptic ulcer disease as young adults and 1% develop gastric cancer in older age There is no association, what so ever, of H pylori infection and recurrent abdominal pain (RAP) Endoscopy is the preferred method of investigation in children with upper digestive symptoms suggestive of organic disease Children with H pylori related disease (peptic ulcer, primary gastric B-cell lymphoma and atrophic gastritis with intestinal metaplasia) but not mere H pylori infection should be treated with the triple drug regimen comprising of proton pump inhibitor (PPI) and two antibiotics for two weeks

Fluconazole prophylaxis against fungal colonization and invasive fungal infection in very low birth weight infants

Abstract: BACKGROUND Fungal infections are common cause of morbidity and mortality in very low birth weight Infants OBJECTIVES To evaluate the efficacy of prophylactic Fluconazole in preventing fungal colonization and invasive fungal infection in VLBW infants. DESIGN Prospective, randomized, double blind placebo controlled clinical trial. SETTING Tertiary level Neonatal intensive care unit. SUBJECTS 120 preterm infants with birth Weight < 1500 g. INTERVENTION Infants were randomly assigned during first three days to receive either Fluconazole or placebo till 28 days or less if, discharged or died earlier. Weekly surveillance cultures from groin, oropharynx, rectum and blood were collected in all patients. Fungal isolates were typed based on standard microbiologic techniques. Liver enzymes were monitored. RESULTS Baseline risk factors for fungal infection in Fluconazole and Placebo groups were similar. Fungal colonization was seen in 30 infants (50%) in the placebo group and 11 infants (19%) in the Fluconazole group (P <0.001). Fungal colonization at rectum, groin and oropharynx was less in fluconazole groups. Fluconazole group showed significantly lower colonizations with Candida albicans but not with C. glabrata. Invasive infection was seen in 15 (25%) infants in Placebo group and 16 (26.7%) infants in Fluconazole group (P = 0.835). Various non-albicans Candida were responsible for 96.8% cases of invasive fungal infection (Candida glabrata 71%, C. parapsilosis 14.7% and C. tropicalis 9.6%). No significant hepatotoxicity was noticed during Fluconazole therapy. CONCLUSION Prophylactic fluconazole during the first four weeks of life is effective in reducing fungal colonization but not invasive infection in VLBW infants.

IAP guidelines 2006 on hospital based management of severely malnourished children (adapted from the WHO Guidelines).

Abstract: Malnutrition in children is widely prevalent in India. It is estimated that 57 million children are underweight (moderate and severe). More than 50% of deaths in 0-4 years are associated with malnutrition. The median case fatality rate is approximately 23.5% in severe malnutrition reaching 50% in edematous malnutrition. There is a need for standardized protocol-based management to improve the outcome of severely malnourished children. In 2006 Indian Academy of Pediatrics undertook the task of developing guidelines for the management of severely malnourished children based on adaptation from the WHO guidelines. We summarize below the revised consensus recommendations (and wherever relevant the rationale) of the group. (excerpt)

Nosocomial pneumonia in a pediatric intensive care unit.

Abstract: BACKGROUND Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence, risk factors and etiological agents of NP in a PICU, is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital, to determine the incidence, etiology and risk factors for NP. MATERIALS AND METHODS Patients admitted to the PICU, over a period of 1 year who had endotracheal (ET) intubation, were enrolled consecutively into the study. Demographic details were recorded at the time of inclusion. Diagnosis of NP was based on CDC criteria (1988). Semiquantiative assay of endotracheal aspirate (ETA) with a colony count of > 10(5) cfu/mL was taken as evidence of infection. Colonisation was defined as isolation of organism with <10(5) cfu/mL. Age, nutritional status, number and duration of intubations, duration of mechanical ventilation, sedation, nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis, were subjected to multiple regression analysis to determine the most important predictors of NP. RESULTS The study group comprised of 72 children with a median age of 3.7 years and boys: girls ratio of 1.9:1. Twenty two of 72 (30.5%) developed NP; the predominant isolates from ETA were Acinetobacter anitratus(12), Pseudomonas aeruginosa (5), Klebsiella sp(3) and Staphylococcus aureus and E.coli(1) each. Additionally 18(39%) had evidence of ET colonization, with Acinetobacter sp being the commonest 9(50%). Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP(OR 0.72, 95%CI 0.55-0.94). Overall mortality was 21%(15/72);7(47%)of these deaths were secondary to NP. CONCLUSIONS NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP.

Nosocomial pneumonia in a pediatric intensive care unti.

Abstract: Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence risk factors and etiological agents of NP in a PICU is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital to determine the incidence etiology and risk factors for NP. Patients admitted to the PICU over a period of 1 year who had endotracheal (ET) intubation were enrolled consecutively into the study. Demographic details were recorded at the time of inclusion. Diagnosis of NP was based on CDC criteria (1988).Semiquantiative assay of endotracheal aspirate (ETA) with a colony count of > 10/5 cfu/mL was taken as evidence of infection. Colonisation was defined as isolation of organism with < 10/5 cfu/mL. Age nutritional status number and duration of intubations duration of mechanical ventilation sedation nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis were subjected to multiple regression analysis to determine the most important predictors of NP. The study group comprised of 72 children with a median age of 3.7 years and boys: girls ratio of 1.9:1. Twenty two of 72 (30.5%) developed NP; the predominant isolates from ETA were Acinetobacter anitratus (12) Pseudomonas aeruginosa (5) Klebsiella sp (3) and Staphylococcus aureus and E.coli (1) each. Additionally 18(39%) had evidence of ET colonization with Acinetobacter sp being the commonest 9 (50%). Re-intubation prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis reintubation was the only independent risk factor for NP (OR 0.72 95%CI 0.55-0.94).Overall mortality was 21% (15/72); 7 (47%)of these deaths were secondary to NP. NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis reintubation was the only independent risk factor for NP. (authors)

Plasmodium vivax cerebral malaria.

Abstract: We report two cases of Plasmodium vivax malaria (both aged 12 years) complicated by seizures and symptoms of diffuse meningoencephalitis. One had predominantly meningeal signs while in the other, purely encephalitis features were present. Both cases were treated with artesunate. Rarely, cerebral malaria is a presenting complication or occurs during the course of P. vivax infection.

Prevalence of eating disorders and psychiatric comorbidity among children and adolescents.

Abstract: There are no prevalence or co-morbidity studies on eating disorders in India. This retrospective chart review studied the prevalence and psychiatric co-morbidity among juveniles with eating disorders. Forty-one cases with ICD 10 diagnosis of eating disorders were identified and analyzed. The prevalence of eating disorders was 1.25% Psychogenic vomiting was the commonest eating disorders and anorexia nervosa the emerging eating disorder. The most common co-morbidities were depression, intellectual disability, and dissociative disorder.

Tobacco consumption and awareness of their health hazards amongst lower income group school children in National Capital Territory of Delhi.

Abstract: Consumption of tobacco is a complex and multidimensional problem faced by the country. It is the main culprit behind oral cancer. The present study was undertaken to assess the prevalence of consumption of tobacco amongst adolescent school children of low-income group in National Capital Territory (NCT) of Delhi and to study the perception of the children regarding the health hazards of tobacco. A cross-sectional study was conducted amongst 3,422 children in the age group of 10-18 years studying in government schools in NCT of Delhi. About 9.8% of the study children had at least once experimented with any form of tobacco in their lifetime. The proportion of children who were "current users" of tobacco products was 5.4% (boys: 4.6%, Girls: 0.8%). Nearly eighty percent of the study subjects knew that, tobacco consumption is injurious to health. The parents of 59% of the children discussed the harmful effects of tobacco consumption with their children.

Role of dexamethasone and oral glycerol in reducing hearing and neurological sequelae in children with bacterial meningitis.

Abstract: The objective was to investigate the efficacy of dexamethasone and oral glycerol in reducing hearing and neurological sequelae in children with acute bacterial meningitis (ABM). The design used was a prospective double blind placebo controlled randomized study. The setting used was a pediatric services of a tertiary care teaching and referral hospital. The subjects that were examined were children 2 months to 12 years with a diagnosis of acute bacterial meningitis admitted between June 2002 to September 2003. Subjects were assigned randomly to receive dexamethasone glycerol dexamethasone+glycerol or placebo. Neurological and hearing impairment was assessed at discharge and after 1 month. 58 children (48 boys 10 girls) mean age 50.2 +or- 41.0 months were studied. Twelve patients received dexamethasone 13 glycerol 20 dexamethasone + glycerol and 13 placebo. Bacterial etiology was ascertained in 24 patients: Streptococcus pneumoniae-10 H influenzae b-7 Staph. aureus-5 and others-2. Three (5.2%) children died during hospital stay and 55 survived. Seven (12%) patients had neurological sequelae (3 in glycerol 3 in dexamethasone + glycerol 1 in placebo group P = 0.29) and 10 patients (17%) had hearing sequelae (2 in glycerol 3 in dexamethasone 2 dexamethasone + glycerol and 3 in placebo group P = 0.68). No significant difference was seen in neurological or hearing outcome with use of either glycerol or dexamethasone in children with acute bacterial meningitis. (authors)

National Family health Survey-3 (2007).

Abstract: Now that most of the data on nutritional status from National Family Health Survey-3 (NFHS-3) is available there is a glimmer of hope and cheer as some of the nutritional parameters seem to have improved somewhat even though the levels of malnutrition remain exceptionally high. Accordingly to NFHS-3 in 2005-06 46 per cent of children under three years of age were underweight 38% were stunted and 10% were wasted. Comparable figures for NFHS-2 (1998-99) are 47 45.5 and 15.5% the situation being worse in rural compared to urban areas. According to NFHS-1 (1991-92) and NFHS-2 (1998-99) child malnutrition sets in very early in life as nearly 12% of 0-6 months old children are underweight. It increases rapidly and by 24 months more than half the children are underweight. It is obvious therefore that for preventing malnutrition the crucial period is birth to two years. Prevention and management therefore primarily has to be at the household level and should become an integral part of an Anganwadi Workers (AWWs) activity and responsibility with active support and collaboration of the health infrastructure. (excerpt)

BMI and body fat percent: affluent adolescent girls in Bangalore City.

Abstract: Objective The present study was conducted to assess the BMI and Body Fat percent among the affluent adolescent girls (n = 794) (9-18 years) and to determine the prevalence of overweight and obesity. Method All measurements were recorded for two and a half years, at six monthly intervals. The study design was crosslinked longitudinal in nature, thus increasing the sample size at the end of the study from 794 to an observational figure of 3970. BMI clubbed with BIA field technique to measure the adiposity (body fat %) were used to assess the overweight among them. Result According to CDC BMI criteria, the prevalence of overweight and obesity in affluent adolescent school girls was seen in 13.1% and 4.3% respectively. The actual body fat per cent values for assessing overweight and obesity among the girls was calculated based on cutoffs of 85th and 95th percentile values respectively. The body fat% 85th percentile values for assessing overweight among the girls ranged from 20.7 to 34.1 and 95th percentile values from 25.9 to 41.2 for ages 9 to 17.5 years respectively. Higher velocity of BMI and body fat per cent were also observed during the pubertal period, between 10 to 12 years among the girls. Conclusion Overweight is an emerging health problem in adolescent girls belonging to affluent families in Bangalore city.

Relationship between insulin resistance and serum levels of adiponectin and resistin with childhood obesity.

Abstract: OBJECTIVE The aim is to study the relationship between insulin resistance and serum adiponectin and resistin in obese children. METHODS A total 113 obese and 37 nonobese children were enrolled and serum adiponectin and resistin were measured. RESULTS Compared with controls, higher insulin resistance by homeostasis model (HOMA-IR) and lower whole body insulin resistance index (WBISI)were found in obese children (all P <0.05). The adiponectin levels in obese children and controls were 3.63 and 5.79 microg/L with a significant difference (P<0.001) while the difference of resistin levels was not significant (P = 0.948). Significant correlations between insulin resistance parameter and age,sexual development, BMI, serum triglyceride, ApoB, LDL-cholesterol, HDL-cholesterol, alanine aminotransferase, uric acid, or adiponectin levels (all P <0.05) were noted. Stepwise multiple regression analysis showed that BMI and adiponectin levels were independent determinants of WBISI. CONCLUSIONS These results suggest that adiponectin may play a protective role in obese children through decreasing insulin resistance.

Effect of iron supplementation on physical performance in children and adolescents: systematic review of randomized controlled trials

Abstract: OBJECTIVE: To evaluate the effect of iron supplementation on physical performance in children (0-18 years) through systematic review of randomised controlled trials (RCTs). DATA SOURCES: Electronic databases, personal files, handsearch of reviews, bibliographies of books, abstracts and proceedings of international conferences. REVIEW METHODS: RCTs with interventions that included oral or parenteral iron supplementation, fortified formula milk, or cereals were evaluated. The physical performance outcomes studied were heart rate, treadmill endurance times, blood lactate, and oxygen consumption. RESULTS: A total of three studies were included, in all of which iron was supplemented in the form of oral medicinal iron. At 5, 6 and 7 miles per hour running speeds, the pooled weighted mean (95% Cl) difference (WMD) in the heart rate (per minute) between the iron and the placebo, following exercise was -7.3 (-19.6, 4.9; p = 0.241), -6.6 (- 19.9, 6.6; p = 0.327), and -8.0 (-19.7, 3.7; p = 0.182), respectively. After excluding the study with nonanemic subjects, the corresponding figures were -13.1 (-23.2, -3.1; p= 0.01), -14.2 (-22.3, -6.1; p = 0.001) and -12.7 (-23.5, 1.9; p = 0.021), respectively. Oxygen consumption, estimated in two studies, showed no significant difference between the treatment groups. Blood lactate levels were estimated in one study only at two different doses of iron, and were significantly lower (p < 0.05) in iron supplemented group in comparison to placebo both before (7.71 and 7.55 mg/dL versus 8.43 mg/dL) and after (14.36 and 14.35 mg/dL versus 16.48 mg/dL) exercise. Treadmill endurance time was significantly better in iron supplemented group when compared with placebo in one study. CONCLUSIONS: Iron supplementation may have a positive effect on the physical performance of children, as evaluated through the post exercise heart rate in anemic subjects, blood lactate levels and treadmill endurance time. In view of the limited data availability, this finding cannot be considered conclusive.

Cytogenetic Analysis of Down Syndrome in Gujarat

Abstract: During 1995 to 2006, 382 cases clinically suspected for Down syndrome were investigated for cytogenetic study. Free trisomy 21 constituted 84.8% of cases, translocation 8.9%, mosaic 3.9% and in 2.4% cases regular T21 was associated with structural or numerical changes. Translocation was parentally inherited in 26.5% cases and maternal transmission was twice as common as paternal. Males were more pronounced to be affected than females in all the groups. 91.6% of DS babies were born to younger mothers (20-35 yr) compared to 8.4% in elderly mothers (>35 yr).

Role of paracetamol in treatment of childhood Fever: a double-blind randomized placebo controlled trial.

Abstract: OBJECTIVE To investigate whether paracetamol administration (i) increases the overall duration of fever; and (ii) is effective and safe, in symptomatic treatment of febrile children. DESIGN Randomized double blind placebo controlled trial. METHODS The trial was conducted at a tertiary care setting. 210 febrile children (6 months - 6 years) with uncomplicated respiratory tract infection received oral paracetamol (15 mg/kg) or placebo, if axillary temperature was 37.6C. Outcome measures included fever clearance time, rate of fall of temperature, percent reduction of temperature, proportion of afebrile children, symptomatic improvement (based on categorical improvement in activity, alertness mood, comfort, appetite and fluid intake) and clinical and biochemical adverse effects. RESULTS Fever clearance time [median (SE, 95% CI)] was comparable between the two groups [paracetamol: 32 (2, 22-37) h; placebo: 36 (1, 33-39) h; P = 0.23]. Paracetamol resulted in significantly higher rate of fall of temperature (paracetamol: 0.33 +/-; 0.16 degrees C/h; placebo 0.07 +/- 0.13 degrees C/h: P <0.001), and percentage reduction of temperature (paracetamol: 85.4 +/- 22.4; placebo 45.5 +/- 34.1; mean difference 39.9; 95% CI 31.9-47.9; P<0.001) during first four hours after drug administration. Proportion of afebrile children after 4 hours (paracetamol: 46.6%; placebo: 12.1%; P <0.001) and symptomatic improvement at 6 hours were significantly higher (P<0.001) after administration of paracetamol as compared to placebo. No serious clinical or biochemical adverse drug effects were observed. CONCLUSIONS Paracetamol achieves effective antipyresis and provides early symptomatic improvement in children with febrile illness without prolongation of fever duration or excessive adverse effects.

Capillaria hepatica infestation.

Abstract: Capillaria hepatica is a very rare zoonotic infestation which primarily infests rodents and is rarely found in humans. The presenting features are fever of unknown origin, hepatomegaly and peripheral eosinophilia. Liver biopsy remains the cornerstone of diagnosis. Treatment of choice is Albendazole and outcome is generally good.

Serum leptin levels in obese Indian children relation to clinical and biochemical parameters.

Abstract: Objective: To evaluate serum leptin levels in obese Indian children and its correlation to anthropometric and biochemical parameters. Design: Cohort study. Setting: Referral tertiary hospital. Methodology: Leptin levels were measured in 36 children (26 boys, age 1.5 to 15 years) and 37 adults (21 men, age 25 to 69 years) with obesity and 29 normal weight controls (15 children and 14 adults). Results: Leptin levels were higher than controls in obese children (19.4 ± 6.4 ng/mL against 5.4 ± 1.7 ng/mL, p = 0.0001) and obese adults (18.9 ± 6.4 ng/mL against 7.8 ± 5.6 ng/mL, p = 0.0001). Leptin levels were higher than males in obese girls (23.5 ± 1.7 ng/mL against 18.0 ±7.6 ng/mL, p = 0.040) and women (21.3 ± 4.4 ng/mL against 15.8 ± 7.4 ng/mL). Leptin levels correlated with body mass index, waist circumference and waistto-hip ratio. A positive correlation was observed between serum leptin and cholesterol, triglycerides and LDL-cholesterol. No correlation was seen with fasting blood glucose and HDL-cholesterol. Conclusions: Leptin levels correlate significantly with anthropometric and laboratory parameters in obese children. There is a need for further studies on the role of leptin in childhood obesity and metabolic syndrome.

Effect of drinking arsenic contaminated water in children.

Abstract: Objective Chronic arsenic toxicity due to drinking of arsenic contaminated water is a major environmental health hazard throughout the world including India. Though lot of information is available on health effects due to chronic arsenic toxicity in adults, knowledge of such effect on children is scanty. A review of available literature has been made to highlight the problem in children. Review methods Scientific publication in journals, monograph, thesis and proceedings of conferences on arsenic in regard to epidemiological, clinical and psychometric studies were reviewed. Results Skin abnormalities including pigmentation change and keratosis are the diagnostic signs of chronic arsenic toxicity in adults. Incidence of skin manifestations vary between 1.9-37.1% in various arsenic exposed children populations in different regions of the world. Occurrence of chronic lung disease including pulmonary interstitial fibrosis was described in arsenic exposed children in Chile. Affection of intellectual function is also reported from Thailand, Bangladesh and India. Conclusion Chronic arsenic toxicity due to drinking of arsenic contaminated water causes significant morbidity in children in different parts of the world.

Impact of training on observer variation in chest radiographs of children with severe pneumonia.

Abstract: Pneumonia diagnosed using chest radiographs is often used as a study end point in trials and epidemiological studies. We studied whether training of the end-users in 172 standardized chest radiographic features will decrease variability in the interpretation. Inter-observer variation of 3 observers in recognizing standardized radiographic features for pneumonia was studied in 172 chest radiographs of children with clinical severe pneumonia. (as per WHO definition). The observers were then trained using a software with a repository of normal and abnormal films showing a spectrum of radiological changes in pneumonia. The inter-observer variation in recognizing the same standardized radiographic features was recorded after this training. For each radiographic feature Cohens kappa statistics to assess the between-observer agreement and Fleisss multiple rater kappa statistics to assess agreement among all three clinicians was used. The uniterpretable films reduced from 16.6% (95% CI 0%-34.1%) before training to 8.1% (95% CI 0%-17.7%) after training. The adequate films increased from 54.2% (95% CI 12.5%-95.9%) before training to 70% (95% CI 46.5%-93.4%) after training. For all features agreement between observers 1 with 2 and 1 with 3 the Cohens kappa improved from poor to moderate agreement. The Fleisss kappa values before training were 0.1 to 0.2 and after training ranged from 0.37 to 0.52 indicating moderate to good agreement after training. Training of the doctors using standardized features with the help of a software improves agreement substantially in identifying radiological pneumonia. (authors)