International Journal of Contemporary Pediatrics

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ISSN / EISSN : 2349-3283 / 2349-3291
Published by: Medip Academy (10.18203)
Total articles ≅ 2,986
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Mahesh Kumavat, Divya Dave
International Journal of Contemporary Pediatrics, Volume 9, pp 719-724;

Background: Dengue infection is the most prevalent arthropod borne viral illness in children associated with liver involvement. In recent studies from India and Thailand, dengue infection was the most important cause of acute hepatic failure in children contributing to 18.5% and 34.3% of the cases respectively. Methods: Hospital based, prospective, observational study in which 120 dengue patients were included in the study. A detailed history and clinical features were recorded on pre-designed proforma. Investigations for dengue and liver function profile were done as per the standard diagnostic work up followed in our hospital. Results: The result of study shows that out of 120 children, 73 (60.8%) have dengue with warning sign, 46 (38.3%) have dengue fever and 1 (0.8%) have severe dengue. Abdominal pain was most commonly seen in the age group of 8-12 year. 20 (16.7%) cases had hepatomegaly and 27% patients had icterus, 83.3% had thrombocytopenia. In our study liver enzyme and severity of dengue fever were significantly associated, although there was no significant association between age group and liver enzyme. The 17.5% cases of dengue viral infection had elevated prothrombin time, and 19.2% had hypo-proteinemia. There was no significant difference between male and female liver profile. Younger age group and complicated dengue viral infection had more abnormal liver profile. Conclusions: Hepatic involvement is more common in severe dengue associated with significant rise of liver enzymes. Hepatomegaly is the most important clinical sign but alteration of liver profile can occur with or without hepatomegaly.
Masoom Nathani, Piali Mandal, Ravinder Kaur, Jagadish Chandra
International Journal of Contemporary Pediatrics, Volume 9, pp 746-752;

Background: Febrile neutropenia is a common complication of anti-cancer chemotherapy. Invasive fungal infections are found mostly after prolonged neutropenia. Early diagnosis and treatment of these infections are of crucial importance. Hence, there is a need to identify the common causative organisms of fungal sepsis in children and our primary objective was to diagnose invasive fungal infections in children of febrile neutropenia and identify the common fungal etiological agents with clinical profile. Methods: This study was done as observational, cross-sectional study for 18 months at the department of microbiology, Lady Hardinge Medical College and department of pediatrics, Kalawati Saran Children’s Hospital. All children less than 18 years of age clinically suspected to have invasive fungal infection with absolute neutrophil count <500 /ml, with fever not responding to antibiotics for more than 3-4 days were included in the study. Results: Hospitalization ≥7 days (100%) was the most common associated risk factor, followed by neutropenia (100%), immunodeficiency (100%), cytotoxic drugs (87.27%) and malignancies (87.27%). Other less commonly associated risk factors were hyperalimentation (23.64%), residence near a construction site (23.64%), presence of urinary catheters (10.91%) and HIV positivity (9.09%). Around 54.54% of sputum samples were positive for fungal culture. A lower positivity was seen in blood culture (14.54%). Conclusions:Candida spp., Aspergillus spp. and Pneumocystis remain the primary fungal pathogens in this patient population. Early clinical suspicion followed by prompt sampling and evaluation for fungal infections may aid in timely diagnosis and reduction of mortality of these patients.
Joseline Daniella González Ibarra, José Maria Zepeda Torres
International Journal of Contemporary Pediatrics, Volume 9, pp 767-771;

Pneumothorax is a condition in which there is free air between the parietal and visceral pleural sheets. The neonatal stage is the most common period when it develops during childhood. It is a problem that requires urgent intervention. We presented the case of a spontaneous pneumothorax in a newborn with positive culture of S. aureus.
Pushpalatha Kariyappa, Dakshayani Manjunath, Sushmitha Sarode, Udayakumar Sseetharam Rao
International Journal of Contemporary Pediatrics, Volume 9, pp 757-761;

Lysosomal storage diseases (LSDs) are inherited metabolic diseases that are characterized by the accumulation of various toxic metabolites as a result of enzyme deficiencies. LSDs comprises of more than 50 diseases and are classified on a biochemical basis and the type of accumulated substrate. Most of the LSDs are inherited as autosomal recessive disorders with a few exceptions. Gaucher disease is the most common LSD. Clinical presentation of these children usually includes- anaemia, easy bruising, abnormally enlarged liver and/or spleen. We report a case series of 12 children with LSD. Among them 9 (75%) with GD, 3 (25%) with MPS. Based on the symptoms, in reducing order of frequency, children presented with generalised weakness, growth failure, abdominal distension, and developmental delay. 3 children with MPS had coarse facial features with reduced joint movements and hearing impairment. On examination, 5 children (41.6%) weighed less than third percentile, 9 (75%) had short stature, 10 (83%) had moderate to severe visceromegaly, CNS involvement in 2 children seen as hypotonia, occulomotor apraxia. Hematological parameters in all revealed- anaemia/leucopenia/thrombocytopenia- with two or more of the cell lines being affected. Bone marrow biopsy done in 9 (75%) children all of which were abnormal. Most of the children had enzyme activity levels between 0 to less than 15% of the normal reference range of the respective enzyme. ERT was initiated in 9 children (7 GD children and 2 MPS child) and followed up, showed a gradual amelioration in the symptoms by 1 year of regular ERT.
Vishal R. Harangulkar, Suryakant Y. Ingale, Snehal G. Murde
International Journal of Contemporary Pediatrics, Volume 9, pp 780-783;

Anaphylactic reaction to lidocaine is a very rare and life-threatening event. Lidocaine (xylocaine) is one of the most common anaesthetic drugs used as local anaesthetics for minor dental and other minor surgical procedure. Although minor allergic reactions after administration of lidocaine are common and easily resolved after just antihistaminic with or without steroid administration. However severe anaphylaxis leading to death is very rare; so much that the physicians might be unaware of its occurrence and its emergency management. From 1957 to 2012, there were seven reports of single case and one report of 8 cases with sufficient information for review. In paediatric patients, very few have history of allergies and due to unawareness of their allergic condition they may land in tragic event of anaphylaxis which if not managed on time can lead to death. We hereby presented such a rare case of a 14 years old female posted for a minor surgical procedure, who had anaphylactic shock due to lidocaine, followed by sudden cardiorespiratory arrest leading to death despite of all the prompt management.
Sai Sunil Kishore Manem, Vijay Karri, Rahul Gorantla, Rama Garuda, Anita Tripathy
International Journal of Contemporary Pediatrics, Volume 9, pp 725-730;

Background: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID is a recently emerged disease and there is limited Indian data. We reported the presentation and clinical course of these children. Methods: All children who had symptoms and signs of MIS-C according to WHO criteria and those positive for SARS-CoV-2, were considered for the study. Clinical features, lab parameters, treatment details and outcome were documented. Results: 104 children, who had MIS-C during the study period. Out of them, 52 (50%) required respiratory support. Among those who required respiratory support 13 (12%) children required invasive ventilation, 11 (10.5%) children could be managed with noninvasive ventilation, whereas 28 (27%) children required supplemental oxygen. 18 (17%) children had signs of myocarditis and left ventricular dysfunction. 12 (11.5%) children had pulmonary edema and Coronary artery dilatation was present in 4(4%) cases. Steroids were used as main stay of therapy. Low dose intravenous methylprednisolone was administered to72(69%); pulse dose methylprednisolone was administered to 12 (12%) children. Intravenous immunoglobulins (IVIG) administered to 20 (19%) children. Among the study group, 103 children survived and one child expired (0.96%). Conclusions: Optimal use of immunomodulators and frequent hemodynamic assessment with functional ECHO to optimize the inotropes, can improve the outcomes among those with myocardial dysfunction.
Probir Kumar Sarkar, Kinkar Ghosh, Nabila Akand, M. Kamruzzaman, Shireen Afroz, Maksudur Rahman, Puspanjali Roy, Maleeha Sheefa, Sheikh Wasik Rahman, Al Reza M. Sayeed
International Journal of Contemporary Pediatrics, Volume 9, pp 698-705;

Background: The objective of the study was to delineate the clinico-epidemiological characteristics of pediatric coronavirus disease-2019 (COVID-19) patients. Methods: This observational study included 290 pediatric patients with a definite diagnosis of COVID-19 admitted to Dhaka Shishu hospital, Bangladesh, from April 2021 to October 2021. Clinical and epidemiological characteristics were analyzed based on demographic data, medical history, laboratory tests, and outcome information. Data analysis was performed with SPSS 26. Ethical measures were taken in compliance with the current declaration of Helsinki, and final analysis was performed using SPSS 26. Results: Of all, 42 (14.5%) were neonates (<28 days), 88 (30.3%) were infants (28 days to <1 year) and 160 (55.2%) were children (1-17 years). The median age of the children was 18 (0.3-204) months, 58.3% were male, 62% had malnutrition, and presented with various clinical presentations. The main symptoms were fever (5.7%) and breathlessness (20%). Approximately 22% of children were asymptomatic, and 57% had at least one comorbidity. Fever and abdominal pain were predominant presenting symptoms in children compared with neonates and infants (p<0.01 for both), while cough and breathlessness were more frequent in infants (p<0.01 for both). The infants suffered significantly from neutropenia and lymphocytosis than neonates and children (p<0.001 for both). The discharge and death rates were 77.8% with 6.9%. Overall case fatality was higher among neonates than others. Conclusions: Compared to other pediatric groups, neonatal case fatality was higher, and COVID-19 in neonates, infants, and children has similar epidemiological and clinical manifestations. The findings from this study might help to guide the development of measures to prevent and treat this ongoing global pandemic of these particular age groups.
Monisha Ramesh, Vivek Chopra, Neeraj Dhawan, Sadbhavna Pandit
International Journal of Contemporary Pediatrics, Volume 9, pp 775-779;

Vitamin D-dependent rickets type 2 (VDDR2) is a rare autosomal recessive (AR) disorder caused either by a mutation in the Vitamin D receptor gene or overexpression of the binding protein leading to end-organ resistance to 1,25 (OH)2 vitamin D3 or defective hormonal actions respectively. It clinically represents growth retardation presenting in the 1st year of life and is frequently associated with alopecia totalis and markedly elevated levels of 1, 25(OH)2 D, which differentiates it from VDDR type 1. We hereby report siblings of a family, who presented with clinical, radiological features of rickets and alopecia totalis. To our knowledge, only a few cases have been reported in literature describing the AR-pattern and low 25(OH)D3 levels in VDDR2.
Syed Tariq, Marwah Mateen, Mohammad Ashraf, Safoora Wani, Javaid Ahmad Bhat
International Journal of Contemporary Pediatrics, Volume 9, pp 736-739;

Background: Critically ill children have disturbed milieu interior and these disturbances can be estimated by measuring how much apart one or many physiologic variables are from the normal range. In critical care units, predicting patients' outcomes is vital to the intensivist. It allows planning early aggressive therapeutic interventions, optimum resource allocation and appropriate family and patient counselling. Methods: The study was conducted in the post graduate department of pediatrics and neonatology of tertiary care hospital. All patients admitted to our PICU for any critically ill ailment were classified into three groups. Results: In our study of 250 patients, study groups were divided into three groups. Group 1 patients with sepsis; group 2 patients with SIRS and group 3 patients without sepsis and SIRS. Ninety-four patients belonged to group 1; 78 belonged to group 2 and 78 belonged to group 3. There were 42, 36 and 27 females in group 1, group 2 and group 3, respectively. Most patients resided in district Kupwara. Most cases had respiratory system involvement. The median albumin creatinine ratio within 6 hours of admission (ACR1) and at 24 hours was 148 mg/g and 97 mg/g, respectively, among survivors and 199.2 and 287 among non-survivors. There were 30 deaths in group 1, 11 deaths in group 2 and 5 deaths in group 3. Conclusions: Microalbuminuria was found in 78.8% of critically ill children at admission. Urine albumin creatinine ratio at 6 and 24 hours of PICU stay was assessed to predict the degree of severity and mortality. It was found to have 88.5% sensitivity and 62.3% specificity.
Munish Guleria, , Ravindra Singh Jadon, Sana Sana, Pritam Yadav, Shreshtha Singh
International Journal of Contemporary Pediatrics, Volume 9, pp 753-756;

Anomalous left coronary artery from pulmonary artery (ALCAPA) is a rare congenital anomaly with a high rate of mortality in first year of life. It is one of the most common causes of cardiomyopathy and myocardial ischemia in children. In the present scenario, computed tomography (CT) coronary angiography is sufficient for the diagnosis of ALCAPA, eliminating the need of invasive angiography. CT coronary angiography performed in infants with suspicion of ALCAPA is technically challenging in terms of acquisition techniques, radiation protection and diagnostic interpretation. In this case series, we present five cases of ALCAPA diagnosed on CT coronary angiography. CT coronary angiography was able to delineate the anomalous origin of left coronary artery (LCA) from pulmonary artery in all cases. Anomalous LCA was noted to arise from posterior pulmonary sinus of pulmonary trunk in four cases and main pulmonary artery in one case. CT angiography also identified the extent of inter-coronary collateral vessels, left ventricular dysfunction and signs of pulmonary hypertension.  
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