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Publisher: Medip Academy   (Total: 12 journals)   [Sort by number of followers]

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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
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International Journal of Contemporary Pediatrics
Number of Followers: 5  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2349-3283 - ISSN (Online) 2349-3291
Published by Medip Academy Homepage  [12 journals]
  • Risk factors in relation to neurological morbidity in children: a study on
           perception of health professionals and parents

    • Authors: K. M. Adhikari, Ashok Bhandari
      Pages: 1782 - 1788
      Abstract: Background: Morbidity resulting from various neurological illnesses is a common reason for seeking regular help from health care facilities. There is increased requirement of awareness about neurological, psychiatric, physical, and developmental disorders in the community. Present study was undertaken to assess the community awareness and perception of risk factors for neurodevelopmental disabilities in children.Methods: The study was conducted with an objective of finding out level of awareness of a group of young health professionals and parents regarding their perception of likely factors that contribute for the occurrence of neurodevelopmental disabilities. This was a cross sectional study with discussion between the participants of various groups by using the method of Focused Group Discussions. Perceived risk factors as emerged during the discussions were free-listed and categorized under Biological/Familial/Genetic factors, Environmental factors, Socio-cultural factors and Economic/ Financial factors.Results: Lack of prenatal care, prematurity, unaffordability of care, low birth weight, malnutrition, infections and lack of maternal education emerged as important risk factors for neuromorbidity as perceived by the participants. Participants also enumerated insufficient knowledge on preventable risk factors, lack of trained manpower and neglect of female children as important contributors to occurrence of developmental disabilities.Conclusions: It is of paramount importance to identify the community perception of the risk factors for developmental disability which gives us an estimate of awareness among people and caregivers. Interventions tailored to the needs based on the level of community awareness help us in better channelling of preventive programmes and strategies. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193700
      Issue No: Vol. 6, No. 5 (2019)
       
  • The knowledge attitude practice regarding swine flu among parents/guardian
           accompanying children attending tertiary care center

    • Authors: Subasakthi A., S. V. Arul Prasath
      Pages: 1789 - 1793
      Abstract: Background: The knowledge, attitude and behavior of the public during an infectious outbreak is important for individual protection as well as to control the spread of the disease in community. The knowledge, attitude and practices regarding Swine Flu and the correlation between Knowledge and Practices regarding Swine Flu among the parents/guardians accompanying the children attending the pediatric department of KGMCH, Nagercoil was investigated in this study.Method: This cross sectional study was conducted among the parents/guardians accompanying the children attending the pediatric department of KGMCH after the epidemic situation. After obtaining written informed consent, participants were interviewed personally through predesigned and pre-tested questionnaire to elicit information regarding awareness of Swine Flu. All data were analysed using SPSS 25 software.Results: Of the 200 people included in the study, 117 (58.5%) knew that it was a viral disease. Of all the participants, 97(48.5%) knew about the respiratory mode of transmission. Only 28% knew about the hand washing to prevent transmission. Around 93% participants told fever as major symptoms and 71% told cough as a major symptom.55% of the participants were scared regarding the deadly nature of the disease. Only 12.5% of the participants practiced hand washing as a preventive measure. Correlation between Knowledge and practice was weakly positive (Pearson correlation 0.252).Conclusion: Knowledge regarding swine flu was average among the study population. TV, friends news channels and Health care workers were found to be the most common sources of information. Lack of awareness regarding key focus areas like hand washing as a preventive measure is of serious concern.  
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193701
      Issue No: Vol. 6, No. 5 (2019)
       
  • Kramer’s scale or transcutaneous bilirubinometry: the ideal choice of a
           pediatrician' can we trust our eyes'

    • Authors: Pearl Mary Varughese
      Pages: 1794 - 1801
      Abstract: Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer’s scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it’s always best to screen for jaundice using Kramer’s scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it’s better to do serum bilirubin levels.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193702
      Issue No: Vol. 6, No. 5 (2019)
       
  • An institutional experience in insertion of hemodialysis catheter and
           peritoneal dialysis catheter for children with end stage renal disease

    • Authors: Anit Joseph K., Vivek P. Sarma, Aravind C. S., Sethunath S., Sivakumar K., Asok Kumar G. M.
      Pages: 1802 - 1806
      Abstract: Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193703
      Issue No: Vol. 6, No. 5 (2019)
       
  • Cerebrospinal fluid procalcitonin: a promising diagnostic tool in
           differentiating bacterial from aseptic meningitis

    • Authors: Mudasir Ahmad, Syed Wajid Ali, Javeed Iqbal, Feroz Ahmad Wani, Javeed Ahmad
      Pages: 1807 - 1813
      Abstract: Background: Procalcitonin in cerebrospinal fluid has been evaluated with regard to its usefulness in distinguishing between the possible causative organisms for infections. CSF PCT as a diagnostic marker has also been evaluated for differentiating bacterial from viral meningitis with conflicting results obtained so far. The current study was designed to see the role of procalcitonin as diagnostic marker and in differentiating bacterial from aseptic meningitis in pediatric age group.Methods: Children from 5 months to 15 years of age who were suspected cases of meningitis and were admitted to Pediatric Department in SKIMS Srinagar, Jammu and Kashmir were included in this case control prospective study conducted from 2014 to 2016. The total number of 200 children participated in the study among which 100 were cases and 100 controls. Serum and CSF PCT was measured by a fluorescence immunoassay using QDX Instacheck with a detection limit of 0.25-100 ng/ml. Data was analyzed by using standard statistical tests using SPSS 20.Results: The mean CSF PCT in ng/ml in our study for viral meningitis was 0.59±0.43 (range=0.00-1.90), for bacterial meningitis 4.92±1.50 (range=2.89-10.82) and for controls 0.22±0.11 (range=0.00-0.32), respectively. CSF PCT was significantly higher in viral and bacterial meningitis as compared to controls (p<0.01) and significantly higher in bacterial meningitis as compared to viral meningitis (p<0.01). An AUC of 1.000 was established using serum and CSF PCT for bacterial meningitis. The diagnostic accuracy of serum and CSF PCT was almost 100% at cut-off of 2.2 ng/ml and 2.89 ng/ml, respectively.Conclusions: Author have concluded that CSF PCT can be used as a diagnostic marker with better results in differentiation of bacterial from aseptic meningitis. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193704
      Issue No: Vol. 6, No. 5 (2019)
       
  • Prevalence of urinary tract infection in malnourished children aged 6
           months to 5 years attending tertiary care centre

    • Authors: Senthil Kumar A., Thannoli Gowthami Gowrinathan
      Pages: 1814 - 1817
      Abstract: Background: Infections are more common in malnourished children, as result of impaired immunity. Unexplained fever and failure to thrive are the common presenting features of urinary tract infection (UTI) in children. In malnourished children, UTI is mostly asymptomatic and is leading to pyelonephritis and renal scarring. The study was done with the aim to evaluate and find out the prevalence of urinary tract infection in malnourished children between 6 months to 5 year and to find out the causative organism and antibiotic sensitivity pattern.Methods: A total of 180 cases of malnourished children were enrolled and clean catch midstream urine sample was collected for urine culture, according to WHO criteria of malnutrition. Children with urinary tract abnormality were excluded from the study. Renal USG was done in all urine culture positive cases.Results: Total of 174 cases was present after exclusion. Of 174 children, 27 (15.5%) children were having UTI. In this study, 37% of children are asymptomatic. E. coli is the commonest organism causing UTI 16 (59%). Other organism are Klebsiella pneumonia 4 (14.9%), Proteus mirabilis 3 (11.1%), and Pseudomonas 3 (11.1%). The order of antimicrobial sensitivity pattern was amikacin (100%)> ciprofloxacin (81.4%)> cefotaxime (7%). Other common drugs have developed resistance to these organisms.Conclusions: Our observations conclude that malnourished children with fever of unknown origin are at risk of UTI. Hence, urine analysis and culture tests are to be done to all malnutrition cases for assisting to diagnose the bacterial infection and providing the appropriate treatment.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193101
      Issue No: Vol. 6, No. 5 (2019)
       
  • A retrospective study on prevalence, bacteriological profile and
           antibiotic sensitivity pattern of urinary tract infection in children of
           2-12 years age in a tertiary care centre, Puducherry, India

    • Authors: Dharmalingam Angamuthu, Chandru Bhaskar, Nalini Aswathaman
      Pages: 1818 - 1822
      Abstract: Background: Urinary tract infections (UTIs) are a common cause of acute bacterial illness in infants and children(1).Diagnosis is often missed in infants and children as urinary symptoms are minimal and nonspecific. It is becoming increasingly difficult to treat due to increasing prevalence of antimicrobial resistance among organisms.Method: It was done as a retrospective cross sectional study conducted on Children of 2-12 years of age suspected to have UTI  from January 2018 to December 2018 in Pediatric Department of AVMCH.Results: Out of 286 children with symptoms suggestive of Urinary tract infection, 22(7.7%) were found to have culture positive UTI with 9.2% prevalence in 2-6 years age group as against 6.4% in 7-12 years of age group. Culture positive UTI was predominantly found in males in 2-6 years age group as against female predominance in 7-12 years age group. E. coli (45.5%) was the commonest organism isolated among them followed by Klebsiella. 90% of organisms were sensitive to Nitrofurantoin  and 80% were sensitive to Amikacin(80%).Discussion: Culture positive UTI  rate varies with gender and age group. It was predominantly found in males in 2-6 years age group as against female predominance in 7-12 years age group. E. coli and Klebsieella were the most common organisms with predominant sensitivity to Nitrofurantoin and Amikacin similar to other studies. Limitation of this study Retrospective study, small sample size and follow up for complications not done.Conclusion: This study concludes E. coli and Klebsieella were the most common organisms with predominant sensitivity to Nitrofurantoin and Amikacin. Antibiotics need to be selected based on organisms and their sensitivity pattern.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193588
      Issue No: Vol. 6, No. 5 (2019)
       
  • Open versus closed peripheral intravenous catheters in neonates: a
           prospective comparative study

    • Authors: Kavitha Gopalan, Kamalarathnam C. N., Ramya S.
      Pages: 1823 - 1828
      Abstract: Background: Open peripheral intravenous (IV) catheters have been routinely used in neonates. Closed catheters have resulted in a longer indwelling time and reduction in catheter related complications such as phlebitis in adults. However, there is paucity of data in neonates.Methods: We conducted this pilot study in a pre-post study design. Open catheters were used in the first phase and closed catheters in the second phase. Hundred babies requiring intravenous fluid therapy for at least 24 hours in this neonatal intensive care unit were included in each group. Indwelling time and the complications leading to removal of the catheter were compared between the two groups.Results: Both groups were comparable in terms of gestational age, day of life, site of cannulation, nature of intravenous fluid and drugs administered. In the open catheter group, there was significant increase in use of inotropes (38% vs 22%; p=0.014) and blood products (16% vs 5%; p=0.011). The mean indwelling time (hours) was significantly greater in closed catheter group compared to open catheter group (47.1±19.4 vs 38.04±17.9; p <0.008). Inotrope use was found to decrease the indwelling time. There was an increase in indwelling time by 8.2 (SE 2.67) hours even after adjusting for use of inotropes. The incidence of catheter related complications was similar in both groups.Conclusions: There is a marginal but statistically significant increase in indwelling time when closed peripheral IV catheters are used in neonates. However, our results would be more meaningful if replicated in a larger randomized controlled trial.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193097
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinical profile of neonates with congenital malformation born at a
           tertiary teaching hospital in a Himalayan state of India

    • Authors: Daizy N. G., Ashish Pradhan
      Pages: 1829 - 1833
      Abstract: Background: Congenital malformations are assuming prominence as a contributor to neonatal and childhood mortality. This study is aimed at identifying the pattern and profile of congenital malformations among neonates delivered in a tertiary teaching hospital in Sikkim which will provide baseline data for future studies.Methods: A hospital based cross sectional observational study was conducted from 15 October 2015 till 15 April 2017 among live newborns delivered in the only teaching hospital of Sikkim. Out of 2521 neonates delivered, 96 neonates met the inclusion criteria. These neonates underwent a detailed clinical evaluation and appropriate investigations. Data collected were entered into Microsoft excel worksheet 2017, SPSS (version 22) was used for data analysis.Results: The occurrence of congenital malformations in the hospital was 3.8%. Neonates with major anomalies were 50% and majority of the anomalies were of genitourinary system (23.96%). The relation between gender and congenital malformation was found to be statistically significant with p value <0.05, predominantly affecting male. Only 6.25% of the malformations were diagnosed prenatally.Conclusions: This study gives data on the pattern and profile of malformation from a geographically isolated place in the Himalayan regions of India which showed some significant variation. It also highlights the lack of adequate facilities for prenatal diagnosis of congenital malformation in these regions.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193099
      Issue No: Vol. 6, No. 5 (2019)
       
  • Fever in the tropics: aetiology and clinical profile of fever of unknown
           origin in children-a prospective observational study in a tertiary care
           hospital in South India

    • Authors: Ramachandran Sumathisri, Karuppiah Pandi, Sadagopan Srinivasan
      Pages: 1834 - 1838
      Abstract: Background: Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical countries with varied aetiology and clinical presentation. Aim of this study is to determine the aetiology and outcome of FUO in Indian children. Study design is Prospective, observational study.  Methods: We enrolled 75 children aged 1 to 12 years who were admitted with fever >8 days to the paediatric department from January 2015 to August 2016. Initial evaluation included complete blood count, peripheral smear, urine analysis, chest radiography, blood culture and tuberculin test.  Results: In 72 children (96%), a definitive diagnosis could be established, whereas 3 children (4%) remained undiagnosed. Most common aetiology of FUO was infectious disease (90.6%) followed by malignancy (4%) and collagen vascular disease (1.3%). Among the infections group, scrub typhus was found to be the commonest aetiology (52%).Conclusions: Infections were the most common etiological factor for FUO in children aged 1-12 years of our region.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193100
      Issue No: Vol. 6, No. 5 (2019)
       
  • Bacterial etiology and antibiotic resistance pattern of neonatal sepsis: a
           study in a tertiary care hospital, in Bangladesh

    • Authors: Mahfuza Shirin, M. Monir Hossain, Manifa Afrin, Mohammad Abdullah Al Mamun
      Pages: 1839 - 1844
      Abstract: Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. The objective of the study was to detect causative microorganisms of neonatal sepsis and their antimicrobial resistance patterns.Methods: This prospective cross-sectional study was conducted from July 2017 to June 2018 in the Department of Neonatal Medicine and NICU of Dhaka Shishu (Children) Hospital (DSH). Neonates diagnosed with probable sepsis were studied. After enrollment, 1 mL blood was taken and sent to Microbiology department of DSH for culture and sensitivity. With baseline characteristics, clinical examination findings and outcome, were also recorded.Results: Rate of isolation of single organism was 9.2% (84/913). Out of 84 isolates, gram negative bacteria were 77.4% with Klebsiella pneumonae being the commonest (35, 41.7%), gram positive bacteria were 11.9% with Staphylococcus aureus and Streptococcus were equal (5, 5.95% each) and the remaining (9, 10.7%) isolated organism was Candida. Most of the isolated gram-negative bacteria were resistant to ampicillin, gentamicin, and ceftazidime; but gram-positive bacteria preserved 20-80% sensitivity. Klebsiella was more resistant than Acinetobacter to amikacin, netilmicin, ciprofloxacin and levofloxacin. Around 45-65% of gram-negative bacteria were resistant to imipenem and meropenem but gram-positive bacteria showed lesser resistance. Among the gram-negative bacteria, Klebsiella and Acinetobacter were resistant to piperacillin as same as carbapenem group, but gram-positive bacteria were 100% sensitive to piperacillin. All the gram-negative bacteria showed more resistance to 4th generation cephalosporin, cefepime than carbapenem. Out of culture positive 84 neonates, 63 (75.0%) were cured but 21 (25.0%) died. Among the 21 expired neonates, 47.6% (10/21) were infected with Klebsiella.Conclusion: This study observed that gram-negative bacteria causing neonatal sepsis predominantly, with emergence of Candida. All the isolated gram-positive and gram-negative organisms were mostly resistant to available antibiotics
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193098
      Issue No: Vol. 6, No. 5 (2019)
       
  • Maternal risk factors and immediate outcome of late preterms

    • Authors: Sahana Giliyaru, Sahaya Nirmala S., Adarsh E.
      Pages: 1845 - 1849
      Abstract: Background: This study was conducted to analyse the immediate outcome of late preterm babies and also to evaluate the various maternal risk factors in these babies so that close monitoring of these babies for the complications is done and immediate problems can be addressed.Methods: Prospective observational study done in level 3 NICU setting for 6 months. All babies born between 34-36/7 weeks are included in the study and they constitute the cases. Term (above 36 weeks 6 days gestation) newborns babies born during the study period are controls. Maternal history is taken in detail. Risk factors during pregnancy including maternal age, gravida, mode of delivery, medical conditions and birth details. Baby details like gestational age, sex, birth weight, and neonatal morbidities are recorded. The babies are either shifted to NICU or to mother’s side based depending on the baby’s condition. All of them are followed up till discharge.Results: 89 late preterm babies born in the hospital during the study period are included in the study. Out of 89 babies 45are females constituting 50.6% and 44are male babies constituting 49.4%. 20 (22.5%) babies had gestational age between 34-35 weeks.29 babies (32.5 %) had gestational age between 35-36 weeks and 40 babies (45%) are between 36-37 weeks of gestation. 47 babies (52.9%) have birth weight between 1.5-2.49 kg.42 babies (47.1%) have birth weight between 2.5-3.5 kg. The number of babies born by LSCS were 48 (54%) and 41 babies 46% are born through vaginal route.42 babies constituting 48.3% are appropriate for gestational age and 43 babies (49.4%) are small for gestationalage.34 (39.1%) babies required NICU admission and 55 (60.9%) babies did not require NICU admission. Among the maternal risk factors PIH was the commonest risk factor in 22babies (24.7 %), followed by PROM13 (14.6 %), oligohydramnios 6 (6.7 %) ,twin gestation 6 (6.7 %), MSAF 3 (3.4%), IDM 3 (3.4%), Antepartum hemorrhage 3 (3.4%), eclampsia 1 (1.1%) and maternal cardiac disease 1.1%. Neonatal morbidities are 25 late preterm babies had jaundice (28.7%) followed by RDS in 15 (17.2%), sepsis in 9 (10.3%), NEC 2 (2.3%), Hypoglycemia 5 (5.6%) late preterm babies required ventilation/ CPAP constituting 5.7%. Surfactant was used in 2 late preterm babies 2.3%. 87 babies (97.8%) got discharged and mortality is 2.2%.Conclusions: Late prematurity is associated with significant neonatal morbidity.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193598
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinical and laboratory evaluation of lymphadenopathy in particular with
           fine needle aspiration cytology

    • Authors: Nageshwara Rao K., Harisha Gopal, Gautham M.
      Pages: 1850 - 1854
      Abstract: Background: To know the various causes of lymphadenopathy in children and to know the usefulness of FNAC in diagnosis of various causes of lymphadenopathy.Methods: Children less than 12 years with significant lymphadenopathy (lymphadenopathy of >1 cm in cervical, axillary and >1.5 cm in inguinal region) were included.Results: A total of 50 children were enrolled in the study. The incidence of lymphadenopathy was more common in the age group of 4-8 year during the lymphoid phase with male preponderance of all the causes infections especially tuberculosis was the major cause of lymphadenopathy which is totally preventable by giving BCG vaccination. The sensitivity of FNAC in the present study was 71.3%. In 3 cases FNAC 69 was not done because peripheral smear examination revealed that the patients are suffering from acute lymphoblastic leukemia.Conclusions: FNAC is a simple bed side investigation though traumatic is of immense value for diagnosing various cases. Even though it may not be a replacement for lymphnode biopsy, it is preferred as a first line investigation because of its simple procedure.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193152
      Issue No: Vol. 6, No. 5 (2019)
       
  • Short stature as a significant marker in celiac disease

    • Authors: Jasraj Bohra, Virendra K. Gupta, Ashok Gupta
      Pages: 1855 - 1858
      Abstract: Background: Celiac disease (CD) is a genetically determined gluten-sensitive enteropathy resulting in nutrient malabsorption, can have extra gastrointestinal tract (GIT) presentations, short stature may be the only presenting clinical feature, even in the absence of gastrointestinal symptoms. The aim and objective of this study was toMethods: This cross-sectional study was performed on 1000 children between ages 5 to 10 year of different schools, in Jaipur, district of Rajasthan. An anthropometric measurement (height, weight) was done for all children. Serum samples were analyze for IgA antibodies to human tissue transglutaminase (tTG) with lower detection limit of 1.0 U/ml and 15 U/ml. Positive samples for tTG antibodies were reanalyzed human endomysial autoantigens (EmA).Results: Out 1000 children screened, six were seropositive, of those four were females and two were males. The serological proportion of CD in this population was 1:166. These Six seropositive group tends to have lower height, weight than the seronegative group, but the difference was only significant for height (P=<0.01).Conclusions: Although gastrointestinal manifestations are important presentation of celiac disease, nevertheless short stature alone or in combination with other symptoms of celiac disease has been present.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193153
      Issue No: Vol. 6, No. 5 (2019)
       
  • Morbidity and mortality profile of preterm neonates admitted in neonatal
           intensive care unit of a tertiary care centre in Western Uttar Pradesh,
           India

    • Authors: Najia Hassan, Sujaya Mukhopadhyay, Sneha Mohan
      Pages: 1859 - 1862
      Abstract: Background: Preterm birth is a major cause of mortality and morbidity for newborns. Complications of prematurity are becoming more common as more survivors are spending time in Neonatal intensive care unit.Methods: A retrospective hospital based clinical observational study was conducted in NICU in Sharda hospital, a tertiary care centre in Greater Noida. Data regarding neonates′ age, sex, clinical presentation, maternal risk factors, complications and outcome were recorded.Results: A total of 133 preterm neonates were enrolled in the study. Maternal risk factors like Pregnancy induced hypertension (PIH) was seen in 19.5% cases, Urinary tract infection in 15% and Antepartum haemorrhage in 14.2% cases. Among the complications of prematurity, RDS was noted in 38.3% cases, Hyperbilirubinemia in 16.5% and feed intolerance in 15% cases. Sepsis was present in 3% of the preterm. Mortality rate was 7.5%. Most common cause of death was RDS.Conclusions: Pregnancy induced hypertension and Antepartum haemorrhage were important maternal risk factors for prematurity. Respiratory distress syndrome and perinatal asphyxia were the important causes of mortality in the present study.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193154
      Issue No: Vol. 6, No. 5 (2019)
       
  • Incidence of complications following umbilical vein catheterisation in
           neonates

    • Authors: Kannan Chinnaswamy, Anandhi Chandramohan, Karthikeyan Kadirvel, Soundararajan Palanisamy
      Pages: 1863 - 1866
      Abstract: Background: Umbilical vein catheter (UVC) insertion in newborns has life threatening complications like Catheter related bloodstream infections (CRBSI), Portal vein thrombosis (PVT) and other mild complications. This study has been done to assess the incidence and risk factors of complications in neonates with umbilical vein catheterisation.Methods: A prospective observational study was carried out in neonates admitted to a South Indian tertiary care hospital between January 2017- June 2018.Results: Umbilical vein catheterisation was done for 65 neonates, of them 46 completed the study. One neonate (2%) developed CRBSI and none of them developed PVT in both baseline and follow up scans. Minor complications noted were repositioning in 26%, umbilical site leak in 23%, reattempts in 19%, catheter block in 13%, periumbilical erythema in 6% and umbilical site bleed in 2%. There was no statistical significance between minor complications and baseline study characteristics.Conclusions: Although UVC is a common and easy vascular access, it is not without complications. Incidence of serious complications following umbilical vein catheterisation is low when proper technique and sterile precautions are followed. However, the occurrence of mild complications following UVC insertion is high.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193160
      Issue No: Vol. 6, No. 5 (2019)
       
  • A study of biochemical abnormalities and manifestations of neonatal
           seizures

    • Authors: Sahaya Nirmala, Sahana Giliyaru, S. C. Karat
      Pages: 1867 - 1871
      Abstract: Background: Neonatal seizure is a common neurological problem in the neonatal period with a frequency of 1.5 to 14/1000 neonates1. Neonatal seizures have always been a topic of particular interest because of their universal occurrence. A varied number of conditions are capable of causing seizures in the neonatal period. The presence of a seizure does not constitute a diagnosis but is a symptom of an underlying central nervous system disorder due to systemic or biochemical disturbances. This study aims to study the various clinical types of seizures and the biochemical abnormalities associated with them.Methods: This prospective study was conducted in the neonatology unit, department of pediatrics, C.S.I. Holdsworth Memorial Hospital, Mysore. Details of history, examination and investigations were recorded on predesigned proforma.Results: Out of total 54 cases, 47(87%) cases had seizures during first 3 days of life and hypoxic ischemic – encephalopathy (HIE) remains the main etiological factor in 20 (37.04%) cases. More than one metabolic abnormality was present in 6 cases. Hypoglycemia & hypomagnesemia were the commonest abnormality in neonates having seizures.Conclusions: A biochemical work up is necessary for all cases of neonatal seizures. The type of seizure does not give much information as to whether the seizures are purely metabolic or organic or about the type of biochemical abnormality.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193161
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinical and epidemiological characteristics of patients with suspected
           primary immunodeficiency disorders attending Alexandria University
           Children’s Hospital

    • Authors: Doaa A. Heiba
      Pages: 1872 - 1880
      Abstract: Background: Current study was conducted to determine the clinical and epidemiological characteristics of patients with suspected primary immunodeficiencies (PID) seen at Alexandria University Children's Hospital.Methods: Eighty one patients with suspected PID were seen at Alexandria University Children's Hospital in one year in the period from September 2016 to October 2017. Demographic data of the patients as well as data related to their disease status were taken and evaluation sheet was developed for all patients.Results: About 61.7% of patients satisfied the criteria of PID based on WHO Scientific Committee. According to modified IUIS classification predominant antibody deficiency was the commonest (34%) followed by other well defined immunodeficiency syndromes (30%), combined immunodeficiencies (16%), phagocytic defects (14%), diseases of immune dysregulation 4% and complement deficiencies (2%). The most frequent disorder was X-linked agammagloulinemia (XLA) (22%). The mean age at diagnosis was 27.4 months. The consanguinity rate was 55.5%. A positive Family history was a strong pointer to diagnosis for PID (46.9%). The commonest clinical presentation was pneumonia (82.7%). 28.4% of patients died from infections. As observed in other patient registries, diagnostic delay remains the major cause of morbidity and mortality.Conclusions: Primary immunodeficiency disorders are not rare in Egyptian children. Creating awareness of PID should be targeted at hospital pediatricians and families with history of PID and this may reveal more cases within the community. The observed high frequency of combined T- and B-cell immunodeficiencies in this cohort made it a health issue in Egypt as in other developing countries.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193599
      Issue No: Vol. 6, No. 5 (2019)
       
  • Etiological study of jaundice in neonates

    • Authors: Jasraj Bohra, Chuba Kumzuk L. C. R.
      Pages: 1881 - 1887
      Abstract: : Jaundice is the commonest abnormal finding with an incidence of about 60% in term babies and 80% in preterm babies. It is the commonest cause of admission to hospitals in the newborn period. In preterm babies, the percentage is exceedingly high due to their physiological handicaps and other hazards of prematurity like Asphyxia, septicemia, respiratory and circulatory Insufficiency. Non-physiological or pathological jaundice is also known to occur in (8-9)% of newborns. Its timely detection and optimal management are crucial to prevent brain damage and subsequent neuro-motor retardation. Aims of this study to find out the etiology of jaundice in neonates, admitted in neonates unit attached to SMS medical college Jaipur.Method: This Observational study was conducted in Neonatal Intensive Care Unit (NICU) and Post Natal Ward attached to SMS medical college Jaipur, after approval from the hospital ethical committee, over a period of 12 months(October 2011 to September 2012. Study was carried on 500 neonates presenting clinically with neonatal hyperbilirubinemia.Result: The onset of jaundice was seen maximum between live hour 24-72 hours (n=290, 58% cases), followed by live hour 72 hours-14 days (n=160, 32%). At more than 2 weeks there was only 3 case (0.6%). The etiological factors in the causation of jaundice in the decreasing order of frequency were exaggerated physiological jaundice accounts for (28%), ABO-incompatibility (24.4%), Rh-incompatibility (13.8%), Idiopathic (10.4%), cephalhematoma (10.2%), septicemia (6%), intrauterine infections (4%), BMJ (1.8%), Galactocemia (0.8%) and G6PD  Deficiency (0.6%) respectively.Conclusion: Hyperbilirubinemia is more severe in newborns, therefore precautionary measure should be adopted by both parents, and clinicians to diagnose and treat the diseases properly.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193600
      Issue No: Vol. 6, No. 5 (2019)
       
  • Etiology and clinico-hematological profile of neonates with pathological
           unconjugated hyperbilirubinemia: a tertiary care centre experience

    • Authors: Sujaya Mukhopadhyay, Najia Hassan
      Pages: 1888 - 1892
      Abstract: Background: Jaundice is visible manifestation of raised serum bilirubin. Jaundice in newborns is not an uncommon occurrence. Usually jaundice in newborn is due to elevation of unconjugated bilirubin. There are varied causes of unconjugated hyper bilirubenemia. This study was conceptualized to see the etiology and clinico-hematological profile of neonates with pathological unconjugated hyperbilirubinemia who were admitted in the specific time frame in Sharda Hospital, Greater Noida which is a tertiary care hospital in Western U.P. Methods: This is a retrospective study in which data of all neonates admitted to NICU with unconjugated hyperbilirubinemia requiring phototherapy and/or exchange transfusion in the period 1.7.2018 to 31.12.2018 was collected and analyzed. History including birth weight, mode of delivery, gestational age, mother's blood group, etc. was recorded. Complete physical examination and investigation done for diagnosis noted. Results: It was seen that out of 438 admissions in NICU, 63% had neonatal jaundice and 18.8% of this had pathological unconjugated hyper bilirubenemia. 63.5% were males and 36.5% females. Majority were term babies. Most of the babies developed jaundice on day 3 of life. In 61% cases no cause for jaundice could be ascertained despite investigations for the same. ABO and Rh incompatibility accounted for 15.30% and 5.7% cases respectively. All patients received phototherapy and 3.8% underwent exchange transfusion. Conclusions: From the study it can be concluded that although blood group incompatibility is an important cause of pathological unconjugated hyper bilirubenemia but in most of the cases no cause is usually found.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193656
      Issue No: Vol. 6, No. 5 (2019)
       
  • Intestinal parasitic infections and prevalence of anaemia among tribal
           school going children: a one year study

    • Authors: Sarvepalli Vijaya Kumar, krishnan Ramalingam
      Pages: 1893 - 1897
      Abstract: Background: Intestinal parasitic infections are one of the neglected tropical diseases listed by world health organization. Parasitic infections among school going tribal children cause significant anaemia and malnutrition. Our study mainly focused on estimating the prevalence of intestinal parasitic infections and focused on iron deficiency anaemia among the tribal school going children.Methods: A prospective study for one year was conducted at a tertiary care hospital and study group was tribal children from hostels and schools. Ethical committee approval was obtained and study included collection of socio demographic data, anthropometric data, stool examination for intestinal parasitic infections, Hb% estimation by “Hemocue globinometer Hb 301 System” a portable hemometer for Hb estimation. S. iron, S. transferrin and Total iron binding capacity were also estimated. Statistical analysis was performed by using SPSS version 20 and analyzed. P value <0.05 was considered significant.Results: This 428 study participants with 66.36% boys and 33.64% girls were enrolled. The prevalence of parasitic infections was 42.06%. Protozoal infections were 41.11% when compared to helminthic infections (26.67%) and mixed infections in 32.22%.  Entamoeba histolytica was the predominant protozoal parasite identified (30%) and Ascaris lumbricoides among the helminthic infection (13.3%). Presence of anaemia in the present study population was 11.21% and among the study group with parasitic infections it was 66.67%.Conclusion: To conclude, regular deworming practices, awareness regarding hand washing practices, iron and folic acid supplementation irrespective of nutritional status and health education could significantly reduce the incidence of anaemia associated with intestinal parasitic infections. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193601
      Issue No: Vol. 6, No. 5 (2019)
       
  • Morbidity and mortality pattern among babies admitted in special newborn
           care unit, Nellore, Andhra Pradesh, India

    • Authors: Lakshmi Prasanna Chintha, Suneetha Bollipo, Ravi Prabhu Gottumukkala, Sathya Prakash Palepu
      Pages: 1898 - 1903
      Abstract: Background: India contributes to 25% of neonatal mortality around the world. In developing countries neonatal mortality is quite high despite of advances in perinatal and neonatal care. The establishment of Special Newborn Care Units (SNCU) has been quite essential in reducing the neonatal morbidity and mortality. This study was conducted to assess the outcome of SNCU at a newly commissioned tertiary care teaching hospital at Nellore District, Andhra Pradesh. Aim of this study the morbidity and mortality patterns in an SNCU at tertiary care teaching hospital.Methods: It was a Retrospective, Hospital based, Descriptive study which was done among neonates admitted to SNCU, Nellore District, Andhra Pradesh for a period of 1 year (January 2015-December 2015). All the neonates admitted to SNCU, Nellore District, Andhra Pradesh during the study period were included in the study. Data was recorded in a predesigned semi-structured proforma. the data was entered into excel-sheet and analyzed using SPSS software version 21.Results: A total of 1015 babies were included in the study. Almost half 592(58.32%) were born in this hospital(inborn) and 423(41.67%) babies were referred from peripheral hospitals and nursing homes (out born). about 3/4th 767(75.5%) of babies were admitted in the first 24 hours of life. Almost half (53.4%) of the study group were male and 46.6% were female. The chief causes of admission in SNCU were Respiratory Distress Syndrome (40.2%) followed by birth asphyxia (19.1%), sepsis (13.3%), Neonatal Jaundice (9.9%) and prematurity (6.6%). In our study 63.0% patients were discharged, 19.3% had left hospital against medical advice, 10.1% died and 7.6% were referred to other institutions for specialized treatment.Conclusion: Respiratory Distress Syndrome, neonatal sepsis, neonatal hyperbilirubinemia, and HIE as the major causes of morbidity. Low Birth Weight and prematurity were the commonest contributors of death, therefore, attempts to prolong the pregnancy each week might improve the neonatal outcome considerably.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193685
      Issue No: Vol. 6, No. 5 (2019)
       
  • Validation of weight, insulin like growth factor 1, neonatal retinopathy
           of prematurity for detecting retinopathy of prematurity among Indian
           preterm neonates

    • Authors: Marthandappa D. H., Vandanapriya N. J., Surabhi H. S., Prathik B. H., Niranjan H. S., Naveen Benkappa
      Pages: 1904 - 1908
      Abstract: Background: Among the premature infants, WINROP (weight, insulin like growth factor 1, neonatal retinopathy of prematurity), a web- based retinopathy of prematurity (ROP) risk algorithm, uses postnatal weight gain in predicting the risk of severe ROP. This retrospective study assess the sensitivity and specificity of WINROP algorithm to predict proliferative ROP (type 1, type 2).Methods: This was a tertiary hospital based retrospective study conducted in level 3 - NICU from February -November 2018. The data was entered in WINROP website. 45 neonates enrolled in the study, were classified as either alarm given (increased risk of severe ROP) or not given (no risk of severe ROP/ no ROP). Timing of alarm was also noted.Result: 10 neonates (22%) had severe ROP requiring treatment. The mean gestational age was 30 weeks and mean birth weight was 1275 grams. In this study, sensitivity to WINROP online system was found to be 90%, specificity of 48.6%, positive predictive value of 33.3% and negative predictive value of 94.4%. The median time from alarm to treatment was 6 weeks (3-8 weeks).Conclusion: WINROP algorithm has a good sensitivity in detection of treatable ROP. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193686
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinico-hematological profile of children with Dengue and co-infection
           with Malaria: a hospital based study

    • Authors: Ayesha Ahmad, Iraj Alam Khan, Mohammad Raza
      Pages: 1909 - 1913
      Abstract: Background: The two most common vector borne diseases in the world are malaria and dengue. Co-infection infection is not unusual in a geographical region such as India, wherein both the vectors coexist. This study aimed to determine whether simultaneous malaria and dengue infection is serious in children than mono infection alone.Methods: In this study all children with fever of less than 7 days duration were included in the study. Clinical inspection and laboratory analysis were performed in all instances, following a detailed history. Children were categorized under 3 categories, malaria (M), dengue (D) and coinfection (DM). For any statistical difference between groups, their clinical as well as hematological parameters were analyzed. SPSS software was used for the statistical studies.Results: Malarial chills fever was also found in a substantial percentage of children with dengue. Superficial as well as profound bleeding were seen more often in the coinfected DM groups than D or M alone. In M group alone, jaundice and diarrhea were noted. In the segregated M and DM groups, the neurological indication, neurological involvement such as altered sensorium and seizure was noted at the same rate, whereas, there had been no occurrence in D group. Anemia was reported in all children, but M group showed the highest drop.Conclusions: Severity criteria, neurological involvement such as altered sensorium and seizures were reported at same rate both in malaria and coinfection, whereas, none of the patients with dengue showed signs of seizure. Anemia relative to hematologic parameters, was considerably more prevalent in the malaria patients. Presence of bleeding in malaria and jaundice in dengue patients, should be considerably investigated for a coinfection.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193687
      Issue No: Vol. 6, No. 5 (2019)
       
  • Predictive value of serum bilirubin level for identifying term neonates at
           risk for subsequent hyperbilirubinemia

    • Authors: Gangina Sriram, R. Rama Krishna Paramahamsa
      Pages: 1914 - 1921
      Abstract: Background: Infants who are clinically jaundiced in the first few days are more likely to develop hyperbilirubinemia. The present study was made attempt to evaluate the predictive value of serum bilirubin level on day one postnatal age for identifying term neonates at risk for subsequent hyperbilirubinemia.Method: The present hospital based prospective study involving neonate’s ≥37 weeks of gestational age included 200 healthy term newborn babies (≥37weeks GA) born at GSL medical college and hospital at Rajahmundry during study period. The purpose of this study was explained to the parents/ guardian and written consent was taken prior to the study. Data collected was kept securely. Permission was obtained from the Ethical Committee of GSL medical College before starting the study.Result: Newborns who developed significant hyperbilirubinemia male: female ratio was 1.07:1. 9(33%) newborns with significant hyperbilirubinemia had jaundice in previous siblings. In the present study, the value of 4.9 mg/dl was determined to have the best combination of sensitivity and specificity to predict neonates at risk of hyper birubinemia subsequently. At this value of 4.9 mg/dl there is high sensitivity and a very high negative predictive value, although a low positive predictive value for predicting neonates likely to develop significant hyperbilirubinemia.Conclusion: Early screening and appropriate management of hyperbilirubinemia is needed for prevention of complications in the newborn. This decreases the significant burden of untreated severe neonatal jaundice, causing potential neurological sequelae. Prediction of neonatal hyperbilirubinemia has widespread implication especially in our country where there are limited resources. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193626
      Issue No: Vol. 6, No. 5 (2019)
       
  • Coagulation Profile in neonates with perinatal asphyxia

    • Authors: Ruchi Jha, Neelam Verma
      Pages: 1922 - 1925
      Abstract: Background: Perinatal Asphyxia refers to a condition during the first and second stage of labour in which impaired gas exchange leads to fetal acidosis, hypoxemia and hypercarbia. It accounts for about 23 per cent of the four million newborn deaths worldwide.Methods: To estimate the magnitude of coagulation derangement in babies who suffered birth asphyxia and compare it with non-asphyxiated controls.Results: There were 61.9% and 64 % males in both the groups outnumbering females suggesting that the health care seeking behavior for male children is more than for their female counterparts. Birth weight and mode of delivery are comparable in both the groups. PT and APTT were significantly higher in the asphyxiated babies than in their respective control group. It may be noted , however, that PT and APTT values were higher in the control group also, when compared with the reference values. This may indicate that the hemostatic mechanisms are already compromised in the newborns and perinatal asphyxia further augment the situation tilting it in favour of bleeding. Thrombocytopenia is observed in the asphyxiated group which may be due to placental insufficiency. Severe bleeding is significant in asphyxiated group as compared to the control.Conclusion: Dyscoagulation should be considered in all asphyxiated babies, and they may present with clinically significant bleeding, which may require fresh frozen plasma to restore and maintain their coagulation status.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193627
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study on clinical profile and risk factors associated with pneumonia

    • Authors: Gangina Sriram, Akula Satyanarayana
      Pages: 1926 - 1930
      Abstract: Background: Modernization, industrialization and urbanization are now posed with the problem of increase in ARI morbidity and mortality. The epidemiological information regarding risk factors and management is scanty. A large gap exists in our knowledge about these factors, which needs to be fulfilled by systematic studies. The present study is designed to identify the risk factors of pneumonia in our area.Methods: This was a prospective clinical study of pneumonia conducted on 94 children who were admitted to Paediatric ward in GSL Medical College General Hospital, Rajahmundry in study duration. Epidemiological factors affecting the same were studied and bronchoscopy was done whenever it was needed. A detailed history of the relevant symptoms, such as fever, cough, rapid breathing, refusal of feeds, noisy breathing, bluish discolouration etc., was collected.Results: The most affected children belonged to the age group of 1 year to 3 years (64.9%). Bronchopneumonia (86.2%) was the most common clinical diagnosis made at admission. According to WHO ARI control programme, 28.7% had pneumonia, 54.3% had severe pneumonia and 17% very severe pneumonia. It was found that younger age group, malnutrition, kutcha house, crowding, poor sanitation facilities, cooking with fuel other than LPG (indoor pollution) and low socio economic status and high respiratory rate were significant risk factors for pneumonia in children.Conclusions: ARI, especially pneumonia is one of the major causes of morbidity and mortality in children. Bronchopneumonia is the predominant form of presentation in infants and preschool children.  
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193688
      Issue No: Vol. 6, No. 5 (2019)
       
  • Profile of estimated glomerular filtration rate of children with Human
           Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

    • Authors: Gabriel O. Ezeh, Oluseyi Oniyangi, Iretiola B. Babaniyi, Vincent E. Nwatah, Felicia U. Eke
      Pages: 1931 - 1937
      Abstract: Background: Kidney disease is more common in people of African descent in developed countries. Studies reporting estimate Glomerular Filtration Rate (eGFR) in African populations and people living with HIV have been carried more frequently on adults than children. The study aimed to assess eGFR by use of the SCHWARTZ formula in HIV infected children seen at tertiary hospital.Methods: A descriptive, prospective and cross sectional study of 221 children with HIV infection. Schwartz formula was used to determine eGFR. The main outcome measures were eGFR. The study population comprised HIV infected children attending Paediatric out-patients’ clinic and those admitted into the Paediatric wards, aged between 6 months and 15 years. Data was analysed using SPSS version 20 and results presented in tables and figures. Results: The age range of the study subjects was 12 months to 15 years with the mean age and SD of 8.21±3.61 years. There were 129 (58.4%) male and 92 (41.6%) female children with male to female ratio 1: 0.7.  The mean age for males was 7.87±3.49 years while that for females was 8.70±3.71 years. The eGFR for the study as determined by Schwartz formula had a range of 49.21 to 463.67 ml/ min/ 1.73m2 with the mean of 159.56±59.04 ml/min. The mean eGFR for the males and females were 166.39±63.54ml/ min and 149.99±45.01 ml/ min respectively. Conclusion: The study, in comparison with other studies, observed a lower prevalence of CKD in HIV infected children. Detection of CKD in HIV infection children may be more optimal if combined methods are employed.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193657
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study on relationship between maternal haemoglobin and the early neonatal
           outcome in term babies

    • Authors: R. Rama Krishna Paramahamsa, G. Kalyan Chakravarthi
      Pages: 1938 - 1942
      Abstract: Background: Iron stores of neonates born to anaemic mothers are low, iron content in breast milk in anaemic women is low and because of these factors substantial proportion of infants become anaemic by six months. Thus maternal iron deficiency and anaemia makes the offspring vulnerable for developing iron deficiency anaemia right from infancy. The current study was made attempt to evaluate and establish the relationship between maternal haemoglobin and early neonatal outcome in term babies.Method: The present cross-sectional observational study conducted in term neonates and their mothers in first stage of labour in the Department of Paediatric and Department of Obstetrics & Gynaecology, GSL Medical College and general hospital, Rajamahendravaram, from 2015 to 2017. Relevant history of mother was recorded and blood sample from the mother was collected in first stage of labour for haemoglobin estimation.Result: The mean haemoglobin in anaemic mothers was found to be 9.48±0.413 gm/dl and that in non-anaemic mothers was 11.67±0.515gm/dl. Anaemia among mothers has significant effect on birth weight of the newborn babies, on crown heel length of the newborn babies (P<0.05) and on head circumference of Newborn babies (P< 0.05). It was found that anaemia among mothers has no significant effect on APGAR score at 5 mins and on hospital stay.Conclusion: Anaemic mothers had newborn with low mean birth weight, low mean head circumference and low crown heel length compared to the those of non anaemic mothers. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193689
      Issue No: Vol. 6, No. 5 (2019)
       
  • A prospective clinical study to evaluate the correlation of duration of
           kangaroo mother care and weight gain in low birth weight babies

    • Authors: Vijayalaxmi Gagandeep, Chaithra R., Febina K.
      Pages: 1943 - 1946
      Abstract: Background: Kangaroo Mother Care (KMC)  is an alternative to conventional neonatal care for low birth weight (LBW)  babies  in low resource settings, this study is to evaluate the correlation between the duration of KMC given and average weight gain per day in low birth weight babiesMethod: It is an observational study, 106 low birth weight babies who were less than 1.8 kg, hemodynamically stable, accepting either direct breast feed or gavage feed were included in the study, duration of KMC given per day and weight was recorded daily until discharge. Babies were monitored for complications, if any  babies were withdrawn from the study , necessary intervention was done. Average weight gain per day in these babies was estimated and correlated with the average duration of KMC.Results: Out of 120 eligible children 106 were selected for study of which 57 were male and 49 were female, 42 were  less than 1.2 kg, 37 were between 1.21 kg to 1.5 kg and 27 were between 1.51 kg to 1.8 kg, there was statistically significant moderate correlation with Pearson r=0.6281 with p value <0.00001 and mean average weight gain was 5.27 in less than  6 hr  to 8 hr, 9.08 in 8 hr to 10 hr, 11.87 in greater than 10 hrs of KMCConclusion: The weight gain was found to increase with duration of KMC practice. hence authors recommend to increase the duration of KMC per day for the good average weight gain per day.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193690
      Issue No: Vol. 6, No. 5 (2019)
       
  • Respiratory variation of inferior vena cava diameter and central venous
           pressure in ventilated and non-ventilated children in fluid refractory
           septic shock: an observational study

    • Authors: Mohd Kashif Ali, Eeman Naim
      Pages: 1947 - 1951
      Abstract: Background: Ultrasound guided fluid assessment in management of septic shock has come up as an adjunct to the current gold standard Central Venous Pressure monitoring. This study was designed to observe the respiro-phasic variation of IVC diameter (RV-IVCD) in invasively mechanically ventilated and spontaneously breathing paediatric patients of fluid refractory septic shock.Methods: This was a prospective observational study done at Paediatric intensive Care Unit (PICU) in Paediatric ward of Jawaharlal Nehru Medical College and Hospital (JNMCH) from February 2016 to June 2017. 107 consecutive patients between 1 year to 16 years age who were in shock despite 40ml/kg of fluid administration were included. Inferior Vena Cava (IVC) diameters were measured at end-expiration and end inspiration and the IVC collapsibility index was calculated. Simultaneously Central Venous Pressure (CVP) was recorded. Both values were obtained in ventilated and non-ventilated patients. Data was analysed to determine to look for the profile of RV-IVCD and CVP in ventilated and non-ventilated cases.Results: Out of 107 patients, 91 were on invasive mechanical ventilation and 16 patients were spontaneously breathing. There was a strong negative correlation between central venous pressure (CVP) and inferior vena cava collapsibility (RV-IVCD) in both spontaneously breathing (-0.810) and mechanically ventilated patients (-0.700). Negative correlation was significant in both study groups in CVP <8 mmHg and only in spontaneously breathing patients in CVP 8-12 mmHg range. IVC collapsibility showed a decreasing trend with rising CVP in both spontaneously breathing and mechanically ventilated patients.Conclusion: Ultrasonography guided IVCCI appears to be a valuable index in assessing fluid status in both spontaneously breathing and mechanically ventilated septic shock patients. However, more data is required from the paediatric population so as to define it as standard of practice.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193691
      Issue No: Vol. 6, No. 5 (2019)
       
  • Comparison of efficacy between levosalbutamol and
           levosalbutamol-ipratropum nebulization in mild to moderate childhood
           asthma

    • Authors: R. Ramanathan, B. Mahalakshmi
      Pages: 1952 - 1956
      Abstract: Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193597
      Issue No: Vol. 6, No. 5 (2019)
       
  • Prevalence of prediabetes in children and its association with risk
           factors

    • Authors: Amitha Rao Aroor, Tharun C. Varghese, Santosh T. Soans
      Pages: 1957 - 1963
      Abstract: Background: Type 2 Diabetes is becoming more common at younger age group. It is important to screen children and adolescents for prediabetes to prevent long-term complications of diabetes. This study was conducted to study the prevalence of prediabetes in children and its association with risk factorsMethods: It is a Prospective hospital-based study. Children aged 6 to 18 years admitted in the Pediatric ward of tertiary care hospital were included. Study was done over a period of 2 years November 2015-October 2017. Participants were screened to find out the prevalence of prediabetes. Prediabetes was defined as fasting glucose concentration (FBS)of 100-125 mg/dl or a HbA1c value of between 5.7% and 6.4%, or a two-hour post-glucose tolerance concentration (OGTT) of 140-199mg/dl.Results: 607 children participated in the study.56.3% were males. Prevalence of Prediabetes was 20.4% with a combination of OGTT, FBS and HbA1c tests. Prevalence by OGTT was 5.9%, HbA1c 4.1% and by FBS was 17.1%. Higher prevalence of prediabetes was associated with male gender, frequent consumption of junk foods, decreased physical activities, overweight, obesity and high waist to hip ratio. Combination of FBS with GTT and FBS with  HbA1c had better sensitivity and specificity when compared to combination of OGTT with HbA1c .Conclusion: Screening of children for prediabetes at younger age especially those with risk factors and intervention with lifestyle modification may help in delaying the progression of the disease. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193705
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study of immunization status of under: five children in relation to
           various demographic variables of their mothers

    • Authors: Khushboo Agarwal, Bhag Singh Karnawat, Monika Singh, Pukhraj Garg, Anil Kumar Jain, Kanwar Singh
      Pages: 1964 - 1970
      Abstract: Background: Immunization remains an important public health intervention. On one side morbidity and mortality caused by vaccine-preventable diseases are still high in developing countries, on the other side immunization coverage is still low. Present study aims to assess immunization status of under-five children in relation to various demographic variables of their mothers.Methods: A total of 530 mothers with children under 5 years attending OPD, immunization clinic or admitted in paediatric ward were included in the study. Maternal demographic variables like age, religion, education, socio economic status, residence, parity and occupation were compared with immunization status of their children.Results: Most of mothers were housewives (73.77%), primary educated (33.58%), belonged to Hindu religion (47.54%), were of 21-30 years age group (52.64%), residing in urban areas (62.07%) and belonged to middle socio economic status (45.84%). Out of total 530 children 161 (30.37%) were completely immunized as compared to 21.32% who were unimmunized. Boys were marginally more unimmunized (37.32%) than girls (23.04%). Mothers’ education, occupation, parity, religion, residence and socio-economic status significantly influenced immunization status of their children (p<0.05).Conclusions: Therefore, it is recommended that any strategy formulated to improve vaccination coverage in children of our country should focus to strengthen above mentioned weak links.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193706
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study of common aeroallergens in children with wheeze: a hospital based
           cross sectional study

    • Authors: Kalavathy Jasmine Masillamoni, Nayantara R. Gandra
      Pages: 1971 - 1975
      Abstract: Background: Prevention of diseases of the allergic origin depends upon the early identification of aeroallergens. Vaccine for allergy may not be required in all cases. but when treatment is not successful, then there is requirement of the vaccine. Objective of study allergens responsible for inducing recurrent wheezingMethods: A cross sectional observation study was carried out at Departmetn of Pediatric, Shadan Institue of Medical Sciences, Peerancheru, Hyderabad, Telangana, India from June 2017 to June 2018 among 100 children with recurrent (4 or more episodes of wheezing in past one year) ages between 2 yrs to 10 yrs. Using the guidelines for skin prick test as per the European committee, the skin prick test was carried out. Insulin syringe was used for the intradermal test. It is done using standardized allergen extracts (Creative Diagnostic Medicare pvt ltd) were done for our cases.Results: Out of 100 children studied, 67 children were found to be sensitive to at least one of the aeroallergen and 33 children were found to be negative for all the aeroallergens. A statistically significant correlation is seen between the age groups and sensitivity (p value 0.025). Out of 67 children with a positive skin prick test, 66 children showed the sensitivity to indoor allergens. The association between the indoor allergens and the wheezing is statistically significant (P value <0.0001)Conclusion: In children the sensitivity to indoor allergens is more prevalent than sensitivity to outdoor allergens. Sensitivity to pollen was found in older children more than 5 years of age.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193707
      Issue No: Vol. 6, No. 5 (2019)
       
  • Knowledge, attitude and practice of acute diarrheal disease and use of
           oral rehydration therapy among mothers of under five children

    • Authors: Achinta K. R. Mallick, Janki Bangari, Shalu S. Kumar, Himani Suyal
      Pages: 1976 - 1980
      Abstract: Background: Acute diarrhea in children is among the commonest causes of outpatient and inpatient attendance in medical setup. Though enough has been done in imparting knowledge about diarrhea and its management, there is a gap between knowledge and practice in the population. Aim of the study is to assess the mother’s knowledge, attitude and practice about diarrhea in children.Methods: Cross-sectional survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra.Results: Of the 305 mothers surveyed, their knowledge about diarrhea was good with 77.1% knowing correct definition, and most mothers knowing correctly about its mode of transmission, the positive role of good hygiene & sanitation, breast feeding and oral rehydration therapy (ORT) in prevention and management of acute diarrhea. However, their attitude and practice were found lacking, with higher rate of bottle feeding (59.3%) and lesser use of standard (46.3%) as well as home based (69.9%) ORT measures.Conclusions: There is discrepancy between the knowledge and practice. Hence, there is the need of sustained efforts in imparting both knowledge and practice among the population.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193708
      Issue No: Vol. 6, No. 5 (2019)
       
  • Cystatin C- an early marker indicative of renal dysfunction in critically
           ill children: a prospective cohort study

    • Authors: Hawwa M.S. Siddiqua, Mathew John, V. C. Manoj, Rati Santhakumar
      Pages: 1981 - 1984
      Abstract: Background: Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few hours or a few days and can also affect other organs such as brain, heart and the lungs. Hence early diagnosis and intervention is needed to improve the outcome of the children. In these studies this objective was to determine if cystatin C is an early marker indicative of renal dysfunction in critically ill children and to determine if Cystatin C can detect Acute kidney injury earlier than serum creatinine.Methods: This prospective cohort study was undertaken in PICU at Jubilee Mission Medical College from December 2016- May 2018. Blood samples were collected from 34 critically ill children for serum creatinine estimation at 0,24 and 48 hours of admission and serum and urine were collected for cystatin C estimation at admission. Children were categorized into AKI and NON-AKI based on pRIFLE criteria. Comparison of cystatin C values with serum creatinine was performed and Statistical analysis was done using IBM SPSS version 20.Results: A total of 34 critically ill children were enrolled in this study, out of which 12 children progressed to AKI during the course of illness according to modified Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE) criteria. We found a strong positive correlation between cystatin C at 0 hours and serum creatinine at 48 hours among AKI groups.Conclusions: Serum and Urine cystatin C are early markers to diagnose AKI in critically ill children. Serum cystatin C is more sensitive than urine cystatin C for the diagnosis of AKI.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193709
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study on etiology and clinical course of neonatal seizures and their
           outcome

    • Authors: Abdul Mohid Syed, Y. Shasidhar Reddy, Gangadhar B. Belavadi
      Pages: 1985 - 1990
      Abstract: Background: The aim was to explore etiology, clinical course of neonatal seizure sand their and outcome in Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.Methods: Retrospective study of 65 neonates from 1 month to 1 year diagnosed with epilepsy between November 2016 to August 2018.Results: Most common type of seizures seen are subtle (40%), followed by multifocalclonic (20%), tonic (21%), focal clonic (9.2%), clonic (7.7%) and myoclonic (1.6%). Most common cause of neonatal seizures was HIE (41.5%), followed by hypoglycemia (13.8%), intracranial bleed (10.8%), septicemia (10.8%), hypocalcemia (7.7%). The morality percentage is high (18.2%) when seizures occurred before 12 hours, when seizures occurred between 24-48 hrs it is 14.3%, and mortality was least when seizures occurred between 2-6 days (12.5%). Seizures are common in stage IIHIE (81.5%) compared to Stage I &Stage III. Seizures with adverse outcome are generalized myoclonic and focal clonic seizures. Focal clonic and focal tonic seizures are most often associated with focal injury. Generalized tonic seizures, motor automatism and some myoclonic seizures are associated with diffuse brain injury. Prolonged seizure activity, seizures lasting for many days, repetitive seizures, and the need for multiple anticonvulsants to control seizure activity are associated with an increased mortality.Conclusions:
      Authors conclude that prompt recognition, evaluation and treatment of these neonatal events are important in improving the survival of neonates with seizures. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193710
      Issue No: Vol. 6, No. 5 (2019)
       
  • Role of serum procalcitonin as a marker for diagnosing neonatal sepsis

    • Authors: Haniya Jafar, Jyotsna Agarwal, Raj Kumar Kalyan, Shruti Radera, Sheetal Verma, Mala Kumar, Shalini Tripathi
      Pages: 1991 - 1997
      Abstract: Background: Neonatal sepsis is a continuing problem causing significant burden on health care, especially in developing world. As blood culture has low sensitivity in diagnosis of neonatal sepsis, strong clinical suspicion along with combination of different laboratory tests is required. The data available for extensively studied acute phase reactant, procalcitonin (PCT) remains controversial. This study was done to assess role of PCT alone and in combination with different tests for diagnosing neonatal sepsis.Methods: Blood samples of 275 neonates (>35 weeks of gestation) admitted to NICU, with suspicion of neonatal sepsis were collected for bacterial culture, serum procalcitonin level and sepsis screen (CRP, mESR, I/T ratio, Total Leucocyte Count, Absolute Neutrophil Count).Results: Blood culture was positive in 30.5% of enrolled neonates. At a cut-off value of 0.5 ng/ml the sensitivity, specificity, PPV, NPV of serum PCT in neonatal sepsis cases was 73.8%, 47.1%, 48%, 80.4% respectively. Serum PCT was found raised in 60 (48.8%) clinically suspected cases of neonatal sepsis where sepsis screen and blood culture both were negative, also it was not raised in 17 (32.7%) of clinically suspected cases of septicemia where both blood culture and sepsis screen were positive. Amongst other individual tests, CRP was found to have best sensitivity (79.7%) and NPV (85%) followed by PCT (73.8% and 80.4%) while best specificity was found for I/T ratio (93.7%) followed by mESR (89%) for diagnosis of neonatal sepsis with positive blood culture. Best NPV was seen for combination of PCT+CRP+I/T ratio (95.6%) for the suspected cases of neonatal sepsis.Conclusions: Thus, we conclude that serum PCT can play a useful role when combined with other test markers but may not find its way as a sole diagnostic marker for diagnosing neonatal sepsis in term/near term babies.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193711
      Issue No: Vol. 6, No. 5 (2019)
       
  • Cardiovascular malformations in infants of diabetic mothers: a
           retrospective study

    • Authors: Poornima Shankar, Jayalalitha S. Marol, Shilpa Deborah Lysander, Abhishek Manohar
      Pages: 1998 - 2002
      Abstract: Background: Despite improvements in medical care provided during pregnancy to diabetic mothers, the cardiac complications in their infants are still more frequent than in infants of general population.Methods: A retrospective case-control study was performed between the years 2017-2018 on two groups of newborns, recording details of outcome of live born babies born to diabetic and non-diabetic mothers.Results: Data were extracted from medical records, and the descriptive and analytical statistics of this information was duly applied. in a total of 50 studied infants, 40 cases (80%) of cardiovascular anomalies have been diagnosed. Most of the cardiac anomaly was hypertrophic cardiomyopathy. The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers (P=0.002). The type of maternal diabetes (diabetes mellitus, overt or gestational diabetes) did not bring about any significant difference in the incidence of cardiac malformations in infants (P=0.406).Conclusions: The incidence of cardiovascular anomalies in infants of diabetic mothers is significantly higher than the infants of non-diabetic mothers. Many of the infants were asymptomatic and therefore clinical examination and follow up in infants of diabetic mothers is important.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193712
      Issue No: Vol. 6, No. 5 (2019)
       
  • Association between serum concentration of vitamin D and development of
           pneumonia

    • Authors: Abrar Ahmed Siddique, Mohammed Abdul Saleem
      Pages: 2003 - 2006
      Abstract: Background: Pneumonia is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with an increased incidence of lower respiratory illness requiring hospitalization. The objective of this study investigated the impact of vitamin D status on the susceptibility of pneumonia in children the design is Case - Control study, Duration of this study is One year (October 2016 -November 2017) and Setting is Niloufer Hospital, Hyderabad, India. In this study participants are 50 children aged 5 months to 5 years with pneumonia and 50 healthy children of the same age were studied.Methods: In this case-control study, children aged 5 months to 5 years with pneumonia were compared with healthy children of the same age as the control group. Serum levels of vitamin D in both groups were measured by chemiluminescence method. Mean serum levels of vitamin D in patients with pneumonia and control groups were compared using t test.Results: The mean serum levels of vitamin D in the group with pneumonia and the control group were 25.98±14.8 ng/mL and 31.18±15.81 ng/mL, respectively. The difference between the two groups was significant. However, this difference was more significant in the age group of 24 to 60 months.Conclusions: According to findings, a low level of Vitamin D is associated with a higher incidence of pneumonia and more severe disease. It is recommended to pay more attention to vitamin D deficiency in infectious diseases, particularly in pneumonia patients.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193713
      Issue No: Vol. 6, No. 5 (2019)
       
  • Assessment of serum ferritin levels in transfusion dependent thalassemic
           children on oral deferiprone in a tertiary care centre

    • Authors: Suman Chirla, Lalita Wadhwa, Puneet Wadhwa
      Pages: 2007 - 2011
      Abstract: Background: Thalassemic patients require regular blood transfusions to maintain haemoglobin level around between 10gm/dl-15gm/dl, which would result in transfusional iron overload. The treatment of iron overload is carried out by using parenteral desferrioxamine (DFX) therapy or recently introduced oral Deferiprone (DFP,L1,Ferriprox,KELFER,CP20) an oral iron chelator, Oral deferiprone, DFP (3-hydroxy-1,2-dimethylpyridin-4-one) is a synthetic analogue of mimosine, an iron chelator isolated from the legume Mimosa paduca. Our study was undertaken to asses ferritin concentration in transfusion dependent thalassemic children on Deferiprone, attending thalassemia clinic in Anil Neerukonda hospital, Sanghivalasa, Visakhapatnam.Methods: The present study was a hospital based prospective study, 50 transfusion dependent thalassemic children on Deferiprone, attending thalassemia clinic in Anil Neerukonda hospital, Sanghivalasa, Visakhapatnam attached to NRI Medical College, Visakhapatnam were enrolled during the study period October 2017 and September 2018.Results: In our study authors found an increase in Serum ferritin concentration from 3067.99±1520.13 to 4281.10 ±1760.42 ng/ml at the end of 12 months, which was quite significant.Conclusion:
      Authors concluded that oral Deferiprone is not an effective iron chelation agent and is associated with complications like GI symptoms, joint pains in significant number of children. So, search for an alternative iron chelator or combined chelation therapies which are safe and cost effective should be continued.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193714
      Issue No: Vol. 6, No. 5 (2019)
       
  • Effectiveness and safety of pidotimod in recurrent respiratory infections
           in children: a pilot study

    • Authors: T. C. Acharya, Kundan Nivangune, Snehal Muchhala, Rishi Jain
      Pages: 2012 - 2015
      Abstract: Background: Recurrent respiratory infections (RRIs) are common in children especially in age 1 to 6 years. Pidotimod, an immunostimulant has been found to lower the recurrences of RRIs and improve the quality of life. The Objective of this study was to assess the efficacy and safety of pidotimod in children with recurrent respiratory infections (RRIs).Methods: In this single-centre, prospective, observational study, children aged 2 to 15 years diagnosed with RRIs were included. RRIs were defined as occurrence of 3 or more episodes of acute respiratory infections (ARIs) or more than 15 days of respiratory symptoms in the past 3 months. These children were treated with pidotimod in addition to standard care treatment. Treatment duration was two months and the follow-up continued for three months. Number of RRIs and severity of RRIs, antibiotic courses and rate of hospitalization before and after treatment were compared.Results: In total 25 children included in the study, mean age was 7.34±3.63 years. Among them, 68% were males. After treatment with pidotimod, there was significant reduction in mean number of ARI episodes (3.84±0.85 at baseline to 0.48±0.51 at follow-up, p<0.0001). Also, there was significant reduction in the duration of acute infectious episodes (p<0.0001), need of antibiotic courses (p<0.0001) and rates of hospitalization (p<0.0001). No safety concerns were identified and pidotimod was well tolerated.Conclusions: Addition of pidotimod to the standard treatment in children with RRIs significantly reduces the recurrence, duration of repeat infectious episodes, need of antibiotic treatments and future rates of hospitalizations. These findings support previous data.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193715
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study on spectrum of heart diseases in children aged 1 month to 12 years
           in a rural medical college in Southern India

    • Authors: Selvakumar R., Vasanthamalar C., Sreeman N.
      Pages: 2016 - 2021
      Abstract: Background: To study the pattern of heart diseases in children aged 1 month to 12 years of age and to assess the pattern, age and gender specific distribution of congenital heart diseases and acquired heart diseases in various age groups like infants, toddler, preschool and school children to prevent morbidity and mortality. To study the various complications associated with various types of heart diseases.Methods: This is a descriptive study of one-year duration in which children with suspicion of heart disease were subjected to ECG, Chest X ray and Echocardiogram. Patients with confirmed heart disease were included and the infants less than 1 month, CCF due to anaemia or without any structural abnormality were excluded.Results: The prevalence of heart disease was 0.9% in author study. VSD is the commonest acyanotic lesion in all age group observed and TOF is the commonest cyanotic lesion. Most of the cyanotic lesions were observed in less than one year. Most of the acyanotic lesions fall within 5 to 12 years. RHD and rheumatic carditis forms the major acquired lesion followed by dilated cardiomyopathy. VSD, ASD, PDA, TOF, Pulmonary stenosis, Rheumatic carditis and MR were predominant in females whereas Aortic stenosis (Bicuspid aortic valve), AV canal defect, TGA, TAPVC were predominant in males. Among the nutritional status 64.2% of patients from acyanotic group and 100% patients from cyanotic group were malnourished. 35% of acyanotic and 100% of cyanotic group were stunted.Conclusions: Acyanotic lesion is the commonest, among which VSD is most common. TOF is the common cyanotic CHD. More than half of the patients were asymptomatic in acyanotic group and presented in the 5- 12 years age group and diagnosed on the basis of clinical suspicion on routine health visits or for some other reason.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193716
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study of blood cultures by BACTEC method in pediatric patients of
           Chhattisgarh, India

    • Authors: Meenakshi S. Morey, Nirmal Channe
      Pages: 2022 - 2026
      Abstract: Background: 356 children aged  between 2 to 4 years admitted at PICU were selected for study B.D BACTEC 9050 system was used for incubation bottle  were incubated until microbial growth was detected, BACTEC 9050 is an automated blood culture system which responds to concentration of  Co2 produced by metabolism microorganism or consumption of O2, needed for growth of microorganism.Methods: The antibiotic used were Amoxicin 250 mcg, penicillin 100 unit linezoid 50 Mcg, vancomycin 50 mcg, ampicillin 100 mcg, Azithromycin 100 Mcg, pipericillin/ Tozabactum, 100/50mcg, ceforazone/ salbactum 50/30 mcg, cefoxitin 50 mcg, cefepime 50 mcg, Amikacin 50 mcg, Imipenen 30 mcg, ceftazidime- clavulanic acid..Results: The observed organized were 90 (25.2%) CoNS, 72 (20.2%) Entrobacter, 70 (19.6%) Klebesiella  spp, 40(11.1%) Enterococcus, 22(6.1%) S, auresis, 22 (6.1%) E coli,  20(5.6%) citrobacters, 20(5.6%) Acinitobacter. This blood culture study  by BACTEC 9050 in pediatric patients in few minutes.Conclusions: BACTEC-9050 method was helpful to treat especially in children because most of diseases in children are idiopathic and life threatening.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193717
      Issue No: Vol. 6, No. 5 (2019)
       
  • Association between breastfeeding practices and anemia in children aged
           6-60 months

    • Authors: T. R. Anjali, Shanavas Abbas, K. E. Elizabeth, M. Leelakumari
      Pages: 2027 - 2031
      Abstract: Background: Anemia is one of the most common nutritional problems in India. Anemia is significantly influenced by dietary factors. Objective was to study the association between breast feeding practices and occurrence of moderate to severe anemia in children aged 6-60 months in relation to those without anemia, admitted to SAT Hospital.Methods: Case control study done at SAT Hospital. 85 moderates to severe anemic children and 85 non anemic children were enrolled in the study. Detailed history was taken including dietary history stressing infant and young child feeding practices. Physical examination was done including anthropometric measurements. Relevant haematological investigations were done.Results: Highest percentage of cases 76.4 % were from the age group 6 months to 24 months. Out of 85 cases 58.8% were with exclusive breastfeeding<6 months and among controls is 37.6%. Association of lack of exclusive breastfeeding for 6 months and anemia is statistically significant. Lack of timely introduction of complementary feeding, poor score for infant and young child feeding practices, male gender, lack of iron rich foods, small for gestational age babies were also significantly associated.Conclusions: Maximum number of anemic children were belonging to 6 months to 24 months, Lack of exclusive breastfeeding for 6 months was a major risk factor for developing anemia in children. Lack of timely introduction of complimentary feeding at 6 months and poor infant and young child feeding practices were significant risk factors for developing nutritional anemia.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193718
      Issue No: Vol. 6, No. 5 (2019)
       
  • Dental caries and oral hygiene practices among school children in Chennai,
           India: a cross sectional study

    • Authors: Shanthi Ramesh, S. Sundari
      Pages: 2032 - 2036
      Abstract: Background: Dental caries is commonly seen among school children. The World Health Organization has stated it to be one of the leading non-communicable diseases. Objective of study the prevalence of dental caries among school children and to study the oral hygiene practices in the occurrence of dental caries.Methods: This cross-sectional study included 307 school children aged 10-15 years. Each child was asked about the dental hygiene practices and was examined for the presence of caries.Results: The prevalence of dental caries among school children was found to be 48.9 % with the 95% CI of 43.3% - 54.4%. The prevalence of dental caries was high among children 10-12 years of age 95(53.6%) compared to 55 (42.3%) among children in the age group of 13-15 years (p=0.05). Daily sweet consumption was significantly associated with a higher prevalence 40 (63.5%) of dental caries (p=0.01). Children not consuming vegetables and fruits everyday had a higher prevalence 76.5% dental caries (p = 0.03). Children who are not practicing night brushing had a higher prevalence of 112 (52.8%) of caries (p=0.04). The study showed that only 17.3% of the children visited a dental health care service.Conclusion:
      Authors found the prevalence of dental caries to be high. Health education regarding the importance of good oral hygiene practices such as night brushing, diet modification and periodic dental visits to all the school children will play a major role in the prevention of dental caries.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193719
      Issue No: Vol. 6, No. 5 (2019)
       
  • A study on the role of paediatric assessment triangle, clinical scoring
           and serum lactate in the management of septic shock in children

    • Authors: Sai Shiva G., V. Suresh Kumar, P. Ram Kumar, S. Bala subramanian
      Pages: 2037 - 2041
      Abstract: Background: There is dearth of studies in India on the management of paediatric septic shock. So it is prudent to do a study on paediatric septic shock management. The objective of the study is to determine the correlation between Paediatric Assessment Triangle and serum lactate levels., to determine the role Paediatric Assessment Triangle in predicting mortality in septic shock and to the determine the role of elevated lactate levels in predicting mortality in septic shock.Methods: Descriptive study of 100 children from 31 days to 12 years of age who are admitted with septic shock in a tertiary care hospital are assessed with paediatric assessment triangle and clinical score and serum lactate was tested along with other standard tests and the children are managed as per the standard protocols. Outcome is analysed.Results: In this study, septic shock children with total clinical score >22 are having statistically significant low levels of diastolic blood pressure and low mean arterial pressure. There was a significant difference in median serum lactate levels between the survivors (28.08 mg/dl) and non-survivors (40.92 mg/dl).Conclusions: Paediatric assessment triangle and clinical scoring based on it more than 22 and serum lactate levels of more than 2mmol/L or 18mg/dl predict the mortality.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193720
      Issue No: Vol. 6, No. 5 (2019)
       
  • Gallbladder motility in children with chronic functional abdominal pain

    • Authors: Raaghul C., Rajesh N. T., Vikrant Kanagaraju, Bharathi Elangovan
      Pages: 2042 - 2045
      Abstract: Background: Chronic abdominal pain is a common gastrointestinal symptom in children that significantly lowers their quality of life. In adults, Gall bladder (GB) hypomotility / dyskinesia is associated with many functional abdominal disorders but there is scarcity of evidence on its role in childhood gastro-intestinal disorders. Aim of the study is to evaluate the GB motility in children with chronic functional abdominal pain (FAP).Methods: Children aged 5-15 years with chronic abdominal pain fulfilling ROME-III criteria and healthy controls were included and all study participants were subjected to ultrasonographic evaluation of the gall bladder volume in fasting state and post - Fatty test meal (FTM) and its ejection fraction was calculated.Results: Sixtysix children including 31 with chronic FAP underwent sonographic evaluation for GB motility. The mean ejection fraction (EF) of cases and controls were 51.72±17.76% and 57.3±23.26% (p value - 0.158). The mean EF of cases with upper abdominal pain and lower/peri-umbilical abdominal pain were 41.7±17.1% and 57.2±15.9% respectively (p value < 0.0001). Increasing BMI had no significant association with GB motility among the participants.Conclusions: There is lack of significant association between children with chronic FAP and GB hypomotility. Children with upper abdominal pain have lesser GB EF, suggesting a possible abnormal GB motility.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193721
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinico-epidemiological study of dengue fever in Ajmer region

    • Authors: Dharmendra Rawat, Kanwar Singh, Pukhraj Garg
      Pages: 2046 - 2052
      Abstract: Background: Dengue infection is a major challenge to public health, especially in South-East Asia. It present with a diverse clinical spectrum. Estimates suggest that annually over 50 million cases of dengue hemorrhagic fever (DHF) occur in Asian countries with a case fatality rate of less than 5%. Of those with DHF, at least 90% are children younger than 15 years old. In humans, dengue infection causes a spectrum of illness ranging from relatively mild, non-specific viral syndrome known as Dengue fever (DF) to severe hemorrhagic disease and death. Definitive early Dengue diagnosis requires laboratory tests and those suitable for use at this stage of illness are either costly, such as RT-PCR for Dengue; not sufficiently rapid, such as virus isolation. Currently test available are NS1 antigen detection and ELISA for dengue, IgM and IgG antibodies. Objective of this study is to study clinico-epidemiological and haematological features of Dengue infection.Methods: Prospective observational study involving initial 100 registered cases who were serologically confirmed dengue infection for a period of one year.Results: DF, DHF and DSS were found in 41%, 53% and 6% patients respectively. Most common presenting complaint and bleeding manifestation were fever and petechiae. Uncommonly altered sensorium and icterus were found in severe dengue infection. 6% patients had coagulopathy, 37 patients had hepatic involvement and 2 patients had deranged renal function who had DSS. Fever was present in (100%) cases of DF, DHF and DSS. 26% patients had their platelet count <50000/mm3.Conclusions: Dengue is a common disease in the India with wide spectrum of clinical presentations, affecting 5-15 years age group children commonly. It is one of the dreaded fevers but early diagnosis and management according to recent WHO guidelines can decrease case fatality rate significantly.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193722
      Issue No: Vol. 6, No. 5 (2019)
       
  • Spectrum of congenital malformations at birth among neonates in a private
           medical college in South Rajasthan

    • Authors: Ravi Bhatia, Gunjan Bhatia
      Pages: 2053 - 2057
      Abstract: Background: Congenital anomalies contribute to about 12% neonatal deaths annually .Neonates with multiple congenital malformations pose a very difficult management problem for the treating physician. This study was done to know the incidence, pattern of congenital anomalies and to study various maternal risk factors leading to congenital anomalies which may help us in devising strategies for better patient counseling and management.Methods: Prospective cross sectional study carried out from 1st Jan 2014 to 31st December 2018 in a private medical college in India. Neonates (both live and still born) delivered in our hospital during this period formed the part of study group. All congenital anomalies present were documented and classified according to system involoved.Results: Total number of neonates with congenital anomalies were 90, out of which 73 were live births and 17 were still births. The overall incidence of congenital anomalies was 2.375%. The commonest system affected was musculoskeletal system (27.7%) followed by CNS (24.4%). Among the maternal risk factors studied, increased maternal age, consanguineous marriage, maternal gestational diabetes mellitus were all significant risk factors associated with congenital anomalies.Conclusion: Congenital anomalies are a global health problem. In our study we have documented that multiparity, consanguinity, diabetes mellitus, Pregnancy induced Hypertension (PIH), maternal anemia, maternal malnutrition to be major contributing factors for congenital anomalies. Present study highlighted that musculoskeletal and CNS systems to be the most commonly affected by congenital malformations. Antenatal scans remain an important diagnostic tool in screening for congenital anomalies. A good clinical examination at birth could help in early detection of life threatening congenital malformation thereby improving chances of his or her survival.

      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193723
      Issue No: Vol. 6, No. 5 (2019)
       
  • Utility of cord blood bilirubin as a predictors of significant neonatal
           Hyperbilirubinemia in healthy term neonate

    • Authors: Rajkumar M. Meshram, Saira Merchant, Swapnil D. Bhongade, Sartajbegam N. Pathan
      Pages: 2058 - 2063
      Abstract: Background: Clinical jaundice is evident in more than two-third neonates in their early neonatal life. Early identification of neonates at risk might allow early intervention and prevent complication. Objective of the study was to assess the cord blood bilirubin level as a tool to screen the risk of development of subsequent significant neonatal hyperbilirubinemia in term neonates.Methods: A prospective observational study was conducted over a period of 2 years on 1040 healthy term neonates. Demographic profile, relevant maternal and neonatal information were recorded. Measurement of cord blood bilirubin, blood group/Rh typing and serum bilirubin at the end of 24 & 72 hours was done to predict significant hyperbilirubinemia.Results: Incidence of significant hyperbilirubinemia was 11.53%. Gender, gestational age, mode of delivery and birth weight had no correlation with development of significant jaundice. 800 (76.93%) neonates had cord blood bilirubin level ≤3.0mg/dl and 240 (23.07%) neonate had cord blood bilirubin level >3.0mg/dl. Out of 240 (23.07%) neonates with higher cord bilirubin (>3.0 mg/dl), 108 (45%) had significant hyperbilirubinemia at the end of 24 hours with sensitivity 90.00%, specificity 85.65%, positive predictive value 45.00% and negative predictive value 98.50% while 110 (45.83%) neonates were observed with serum bilirubin >17mg/dl at the end of 72 hours with cord blood bilirubin >3mg/dl with sensitivity 91.67%, specificity 84.52% positive predictive value 45.83% and negative predictive value-98.61% and this difference was statistically significant.Conclusions: Neonates with cord blood bilirubin level ≤3mg/dl can be safely discharged early whereas neonates with bilirubin >3mg/dl will need close follow up to check for development of subsequent significant jaundice. Hence cord blood bilirubin levels help to determine and predict the possibility of significant jaundice among healthy term neonates.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193724
      Issue No: Vol. 6, No. 5 (2019)
       
  • Study of morbidity pattern and outcome of patients admitted in paediatric
           intensive care unit in a tertiary care rural teaching hospital

    • Authors: Vijay L. Bhavari, Deepali A. Ambike, Neil D. Pawar
      Pages: 2064 - 2067
      Abstract: Background: The care of the critically ill children remains one of the most demanding and challenging aspects in the field of paediatrics. The main purpose of Paediatric Intensive care unit is to prevent mortality by intensively monitoring and treating critically ill children who are considered at high risk of mortality. In the developing countries, there is a scarce data on paediatric critical care. Evaluation of the outcome of medical interventions can assess the efficacy of treatment. This helps in better decision making, improving the quality of care and modifying the future of management if required. This study will also help to study the causes of morbidity and mortality among paediatric age group in our hospital. Aims and Objectives of the study is to evaluate the morbidity pattern and outcome of admissions in the PICU of a rural teaching hospital, and to take measures to prevent morbidity and mortality by improving critical care facilities.Methods: This was a retrospective study, the cases admitted in paediatric ICU in our teaching hospital in last two and a half considering the estimated sample size. Data will be collected from PICU and Medical record Department. Details will be studied with the help of medical record and will be analysed and interpreted according to the medical record details.Results: During a period of 30 months of the study, total of 417 patients were admitted in our PICU. Of the total cases studied, Maximum i.e. 180(43.2%) had age below 1 year. The minimum – maximum range of age was between 1 day to 18 years. About 228(54.7%) cases were males and 189(45.3%) were females. The most common diagnosis was LRTI which was observed in 61(14.7%) of cases. The most common system involved was respiratory system which was observed in 101(21.8%) cases. Of total cases studied, 357(85.6%) were discharged, 36(8.6%) had DAMA (discharge against medical advice) and 24(5.8%) expired.Conclusions: Mortality was low in our PICU. We conclude based on the present study that in our rural set up PICU, with better treatment protocols, skilled expertise/ Paediatric Intensivist we have chances to facilitate the care of critically ill patients giving desirable outcome.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193725
      Issue No: Vol. 6, No. 5 (2019)
       
  • Neonatal hearing screening- time to make a noise- experience from a
           private medical college in South Rajasthan

    • Authors: Ravi Bhatia, Rajendra Gorwara, Rajendra Gorwara
      Pages: 2068 - 2072
      Abstract: Background: Neonatal Hearing Loss has a prevalence that is twice than that of disorders like congenital hypothyroidism, phenyl ketonuria etc. Early detection of hearing impairment is vital since early intervention in form of hearing aids and speech therapy would help lead a child a normal life. The aim of the study was to set up a neonatal hearing screening program and to study the various risk factors which could be associated with hearing loss.Methods: The prospective descriptive study was carried over a period of two years. All neonates before being discharged were subjected to OAE. OAE was done on Oto Read Machine (Intra acoustic) and BERA was done on BERA eclipse machine (Intra acoustic). Babies who failed the first OAE were called back for a repeat OAE at six weeks of age. Babies who failed the second OAE were referred to a trained audiologist for BERA which was performed on BERA Eclipse machine.Results: Out of 1114 neonates screened, 285 neonates failed the first OAE and were called back at six weeks for repeat OAE. Out of the 285 babies who were called for repeat OAE, 258 turned up 27(9.47%) were lost to follow up. Out of the 258 babies who turned up, 245 passed the test while 13 failed the test. 13 Babies who had failed the second OAE screening were called back 1 month later for BERA testing. Out of the 13 babies who turned up for BERA testing, 12 passed the test and 1 failed giving us a prevalence of 0.89 per 1000 population. Of the various risk factors studied only low birth weight was found to be having significant association with hearing loss.Conclusion: Neonatal hearing screening is the need of the hour. Larger multi centric studies are required to establish the prevalence of hearing impairment among newborns.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193726
      Issue No: Vol. 6, No. 5 (2019)
       
  • Investigation of Von Willebrand disease in children with epistaxis and
           clinical practical approach

    • Authors: Hakan Sarbay
      Pages: 2073 - 2076
      Abstract: Background: The absence of a standardized approach to the disease and bleeding history can lead to unnecessary patient consultations and sometimes late diagnosis. The aim of this study was to investigate von Willebrand disease (VWD) in patients presenting with epistaxis with clinical practical approach.Methods: 63 Patients who were admitted to the pediatric hematology and oncology clinic between June 2017 and June 2018 with a complaint of epistaxis were evaluated. Patients diagnosed with VWD were classified as group 1, patients without VWD considered as group 2. The two groups were compared in terms of number of additional symptoms, and family history.Results: There was no difference in terms of age and gender when compared with 42 patients not considered as VWD (group 2), number of additional symptoms, and family history were significantly higher in the group considered as VWD.Conclusions: Excess number of additional bleeding symptoms, and bleeding history in family are of importance for the suspicion of diagnosis of VWD for physicians with limited experience in terms of bleeding disorders in primary and secondary health care institutions.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193727
      Issue No: Vol. 6, No. 5 (2019)
       
  • Electrolyte disturbance in rotaviral diarrhea and other acute diarrheal
           diseases in children under 5 years

    • Authors: Keerthana T. N. Gubbari
      Pages: 2077 - 2080
      Abstract: Background: Acute diarrheal disease is one of the most common cause of mortality and morbidity in under 5 children. Rotavirus is one of the important cause of diarrhea in under 5. This study was done to know the electrolyte disturbance in under 5 children with diarrhea.Methods: A prospective observational study was conducted in Masonic Medical Centre for Children, Coimbatore on children aged less than 5 years with acute diarrhea with moderate and severe dehydration.Results: Total 220 children are included in study, among them 66(58.9%) had rotavirus infection. Among 220 cases of diarrhea 14.09% (31/220) had hypernatremia, 2.72% (6/220) had hyponatremia, 4.54% (10/220) had hyperkalemia and 9.09% (20/220) had hypokalemia. Among 66 cases of rotavirus diarrhea, 27.27% (18/66) had hypernatremia, 4.5% (3/66) had hyponatremia and 25.75% (17/66) had hypokalemia.Conclusions: Hypernatremia is the most common electrolyte disturbance in acute diarrheal diseases and most frequently seen in rotavirus diarrhea. In most of the situation, there is unavailability of laboratory or time lag in obtaining reports. Hence prediction of electrolyte disturbance and management is more important in diarrheal disease.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193728
      Issue No: Vol. 6, No. 5 (2019)
       
  • Effect of deferasirox on serum ferritin level in children with thalassemia
           major: impact of transfusional iron load

    • Authors: Santosh K. Shukla, Anubha Shrivastava, Prakash C. Mishra
      Pages: 2081 - 2086
      Abstract: Background: Ongoing transfusional iron load (TIL) is an important determinant while deciding starting and subsequent dose adjustment of deferasirox during course of chelation therapy. So present study aims to find out effect of different dosing of deferasirox over the serum ferritin level in children with thalassemia major with impact of rate of transfusional iron load.Methods: This one year observational study was carried out in 35 transfusion dependent β-thalassemic patients aged 2-18 years. Patients with baseline serum ferritin 1000-1500ng/ml and/or receiving TIL 0.2-0.3mg/kg/day were started 20mg/kg/day deferasirox and patients with ferritin>1500ng/ml and/or having TIL > 0.3mg/kg/day were started 30mg/kg/day deferasirox. Serum ferritin was repeated in every three months. Dose adjustments were performed on serum ferritin trends in steps of 5-10mg/kg /day to maximum 40mg/kg/day. Evaluation of relationship between dose adjustment, percentage of reduction in serum ferritin and TIL was done.Results: Group-1 patients(42.8%) had TIL 0.2 to 0.3mg/kg/day whereas Group-2(37.1%) and Group-3(20%) children had TIL >0.3-0.4mg/kg/day and >0.4 mg/kg/day respectively. Starting dose of deferasirox in 25.7% patients was 20mg/kg/day and in rest were 30mg/kg/day. Average dose of deferasirox in group-1 was significantly lower as compared to group-2 and group-3 patients ( p< 0.05). Significant decline in mean serum ferritin was observed in all three groups (p < 0.05). There was a significant positive correlation between TIL and average drug dose prescribed (r=0.5411and p=0.0007) but negative insignificant correlation was observed with percentage of reduction in serum ferritin(r=0.0027and p=0.98).Conclusions: Deferasirox 30mg/kg/day significantly reduces serum ferritin and is well tolerated in majority of patients having TIL 0.3-0.4mg/kg/day where as 20mg/kg/day is required in patients having low transfusional iron intake.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193729
      Issue No: Vol. 6, No. 5 (2019)
       
  • Profile and pattern of primary vesicoureteral reflux in children seeking
           care at a tertiary care teaching centre of Southern India

    • Authors: Shivana Gouda, Sonia Bhatt, Dilip Kumar Mishra, Madhu Sudan Agrawal
      Pages: 2087 - 2090
      Abstract: Background: Previous studies have suggested that the clinical features of vesicoureteral reflux in infants differ from those of older children with regard to the male-to-female ratio and severity of renal parenchymal damage. Aim of the study is to know the profile and pattern of primary vesicoureteral reflux in subjects seeking care at a tertiary care teaching centre of southern India.Methods: This was a hospital based study, conducted at the Department of Paediatrics, Kasturba Medical College located at Manipal during August 2004 - August 2012 over a period of 8 years. All the children in the age group of 1 month to 18 years with Vesicoureteral Reflux, who presented to the study centre during study period, were included in the study.Results: Majority (78.5%) presented before 5 years, youngest age at presentation was 1 month and oldest at 14 year 8 months. Among 93 children studied, 65 were males and 28 were females with male to female ratio of 2.3. The commonest presenting complaint was fever (58%), followed by recurrent Urinary tract infection (UTI) (40.8%), dysuria 32 (34.4%) and reports of documented UTI was available in 23 (24.7%) cases. Four children had hypertension at presentation. Thirteen of them had associated posterior urethral valve. Neurogenic bladder was present in 3 children, 2 had associated Anorectal malformation and one had meningomyelocele.Conclusions: Majority of vesicoureteral reflux cases presented before 5 years of age. There was a preponderance of males. Majority had grade IV and V reflux. The mean age at presentation of vesicoureteral reflux was 3.6 years. The commonest presenting complaint was fever, followed by recurrent UTI.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193730
      Issue No: Vol. 6, No. 5 (2019)
       
  • Inappropriate maternal perception of child’s weight status: a
           potential threat to nutrition

    • Authors: Parima Dalal, Rekha Thaddanee, Arun Parikh, Hasmukh Chauhan, Shamim Morbiwala
      Pages: 2091 - 2097
      Abstract: Background: This study was done to know the maternal perception of weight of their children and correlate it with exact weights. We also studied various factors affecting ability of a mother to perceive her child’s weight status.Method: This prospective study was done in Pediatric Department of a tertiary care teaching hospital of Western Gujarat, India, from January 2018 to September 2018. 897 mothers of children < 5 years of age were included. Socio-demographic and anthropometric details of child and mother were recorded. Maternal perception of their child’s weight status was enquired. A correlation between perceived and actual child weight status was estimated.Results: 897 patients <5 years of age had mean (SD) age of 28.66 (±17.04) months, weight 10.17 (±3.5) kg, height 0.81 (±0.15) meters and BMI 15.74 (±15.26) kg/m2. 34.7% of mothers perceived underweight erroneously as compared to actual weight status being normal (p value=0.00001). Misperception (under or over) of the mothers for their children weight status was significant for girls (p=0.011). Significant difference between perceived and actual weight status was seen in birth orders 1 to 4. 34. 6% actual UW children were perceived as NW by < 40 years age mothers (p=0.0018). 78.2% uneducated and 81% of primary or secondary educated mothers from lower SES felt their children were of NW status whereas actually 43.4% and 50.3% children were of NW status respectively (p=0.00001). Surprisingly, 91.3% of graduate or postgraduate mothers of middle SES perceived their children as NW status while actually only 39.1% were of NW and 52.1% of UW (p=0.00001).Conclusion: Half of the mothers were not able to perceive correct weight status of their children. Misperception was significant for girls. Significant difference between perceived and actual weight status was seen for birth orders 1 to 4. Mothers <40 years of age significantly failed to perceive actual UW status of the children. Both educated and uneducated mothers misclassified their children’s weight status significantly.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193731
      Issue No: Vol. 6, No. 5 (2019)
       
  • Anthropometric surrogates to identify low birth weight babies: hospital
           based cross-sectional study

    • Authors: Jyothi S. D., Raghavendra Doddamani
      Pages: 2098 - 2102
      Abstract: Background: Birth weight acts as a crucial sensitive and reliable tool to prevent infant and child morbidity and mortality. There has been a considerable interest in recent years for using simple anthropometric measures as an alternative to birth weight. Objective of the study is to determine the cut off values of the anthropometric measurements and to assess the accuracy of the anthropometric surrogates to identify low birth weight babiesMethods: This is a cross sectional study conducted for a period of one year from 1st Dec 2011 to 31st Nov 2012 at Christian fellowship hospital, Oddanchatram, Dindigal, Tamilnadu. Study population included all the live newborns of term gestation at the hospital. A total of 500 newborns were included in the study during the period. Birth weight of the newborn was measured using spring scale to the nearest 25 grams. Head circumference, Chest circumference, Mid Upper Arm Circumference, Foot Length, Thigh circumference, Calf circumference, Crown-hell length were measured using proper guidelines to the nearest 0.1 cm.Results: In the present study, low birth weight was present in 262 (52.4%) of the newborns. Thigh circumference with cut off value of 15 cm had higher sensitivity and specificity of 97.5% and 80.9% respectively. It was followed by Mid upper arm circumference with cut off value of 10 cm, sensitivity of 81.5% and specificity of 93.9%. Thigh circumference and mid upper arm circumference had high area under curve of 0.949 and 0.855 respectively. All the anthropometric measurements were statistically significant at 5% level of significance.Conclusions: Thigh circumference with a cut off of 15 cm, followed by mid upper arm circumference of 10 cm were the better surrogate anthropometric measurements with better sensitivity, specificity to identify low birth weight babies.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193732
      Issue No: Vol. 6, No. 5 (2019)
       
  • Knowledge, attitude and practice of fever and febrile illness among
           parents of under five children

    • Authors: Achinta K.R. Mallick, Shalu S. Kumar, Janki Bangari, Himani Suyal
      Pages: 2103 - 2107
      Abstract: Background: Fever in children is the commonest cause for outpatient and inpatient admissions in the health care setup. Though most fever episodes are benign with self-limiting course, it is often a reason for anxiety and concerning for parents. The aim of the study was to assess the parental knowledge, attitude and practice regarding fever in children under five years of age.Methods: A cross-sectional question based survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra from parents of under five children, presenting for any consultation from July 2018 to December 2018.Results: There were 636 respondents who completed the study. 38.1% were males. Mean age of responders was 26.85 years (SD 5.12 Range 18 to 37 years). Most of the population were educated lot. 55.5% responders defined fever correctly. There was a huge gap in the parent’s knowledge attitude and practice in fever and it’s management. Lack of information and fear of any untoward incident occurring due to fever were the reason for parental anxiety, frequent medication & combination antipyretic use, and pressure on part of health professionals to increase antibiotic prescriptions.Conclusions: Lack of parental knowledge of fever and fever management in younger children is of concern in the community in spite of improvement in the educational level of parents. There is a utmost need to spread awareness in the community about the benign and the self-limiting nature of most febrile illnesses.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193733
      Issue No: Vol. 6, No. 5 (2019)
       
  • Awareness, attitude and practice of breast feeding among mothers at
           tertiary care center, Puducherry, India

    • Authors: A. Dharmalingam, Chandru Bhaskar, N. S. Raghupathy
      Pages: 2108 - 2111
      Abstract: Background: The knowledge and practice of exclusive breastfeeding has been prejudiced by demographic, social, cultural, biophysical, and psychosocial factors. About two-thirds of under-five deaths in India are associated with inappropriate infant feeding practices. Objective of this study was to assess the awareness, knowledge and practice of breastfeeding among the mothers attending to the tertiary care institute at Puducherry, India.Methods: This hospital-based, cross-sectional study was carried out among 150 postnatal mothers who attended immunization clinics, post-natal and paediatric wards at the tertiary care hospital at Puducherry collecting data about breastfeeding knowledge and practices using a structured interview.Results: The breastfeeding practices were significantly poorer in terms of initiation, feeding colostrums, timing and frequency of feeding and inclusion of pre-lacteal feeds among obese women compared to the normal weighted mothers. The breastfeeding knowledge and attitude was healthy among the mothers as depicted by the awareness of nutritive value of breast milk by majority (84%) of mothers.Conclusions: The mothers had poor knowledge regarding initiation of breastfeeding and administration of colostrum. There was a positive attitude about exclusive breastfeeding, frequency of feeding and social aspects of breastfeeding.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193734
      Issue No: Vol. 6, No. 5 (2019)
       
  • Integration of case based learning and bedside teaching in undergraduate
           students in pediatrics

    • Authors: Suhas P. Kulkarni, Anil B. Kurane
      Pages: 2112 - 2115
      Abstract:  Background: Teaching undergraduate students by bedside clinics has remained cornerstone of medical education because it imparts knowledge, teaches proper behaviour and can be used to teach skills effectively. Case based learning (CBL) is a newer modality of teaching in medical education. CBL involves preparing students for clinical practice through use of authentic clinical cases.  Aim of the study is to study the effect of integration of case based learning and bed side clinic on motivation, deep thinking and cognitive improvement in final MBBS studentsMethods: The study group was undergraduate students of final MBBS posted for clinical posting in pediatric ward. The study was carried out on 59 students posted from March 2018 to September 2018. MCQ based pretest was done initially. The students were taught the topic by case based learning method for one hour. They were asked to take the case and bedside clinic was conducted. Relevant clinical examination was demonstrated to the students. Students were asked to practice the skills in front of the teacher. This was followed by the post-test and   questionnaires.Results: 88.67% students thought that this method was motivating. 82.7 % students perceived that it increases deep thinking. 52.83% students showed more than 20% improvement in score of pre-test and post-test.Conclusions: Integration of case based learning with bed side clinic was associated with Better motivation of final year MBBS students and development of deep thinking in students.  3. Significant change in cognitive learning in final MBBS students.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193735
      Issue No: Vol. 6, No. 5 (2019)
       
  • Body fat indices for identifying risk of hypertension in Indian children

    • Authors: Vairamuthu G. S., Thangavel A.
      Pages: 2116 - 2120
      Abstract: Background: Studies in India shown high body fat indices were strongly associated with hypertension in Indian children, but such studies mostly not done in southern states of India. So, authors include children in Tamilnadu measure body fat indices and blood pressure to find which body fat index correlates closely with hypertension.Methods: Standing height was measured using stadiometer. Weight was measured using electronic scale. WC measured in standing position, by a stretch resistant.  WC above 90th centile will be considered as Adipose. Waist to height ratio optimal cut-off value is 0.44 for children. TSFT recorded using Harpenden caliper, on the non-dominant upper arm. Wrist circumference measured using stretch resistant tape.Results: In this study 2000 children were participated. More hypertensives are seen in 10 to 12 years(62) and 16 to 18 years(31).Increased weight correlated with hypertension. Study indicates waist circumference is significantly correlated with systolic BP p<0.003, diastolic BP p<0.000. This study shows significant correlation p<0.003 for systolic and p<0.000 for diastolic BP with triceps skin fold thickness estimation. In multivariate analysis with systolic blood pressure and diastolic blood pressure shows very strong correlation with waist circumference, waist to height ratio and triceps skin fold thickness.Conclusions: In this study we investigate the correlation between body fat indices and blood pressure correlation was statistically analyzed which shows that waist circumference, waist to height ratio and triceps skin fold thickness were strongly correlated with systolic and diastolic BP.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193752
      Issue No: Vol. 6, No. 5 (2019)
       
  • Etiological spectrum and short term outcome of acute kidney injury in
           children: a prospective study

    • Authors: K. Mahesh, Vishwanath B., Kalpana S.
      Pages: 2121 - 2124
      Abstract: Background: Acute Kidney Injury is a common condition in critically ill children, and it is independently associated with increased mortality. Etiology of AKI in admitted patients is multi factorial. The present study was conducted to determine possible etiologies and to know short term outcome.Methods: A prospective case series study was conducted in our PICU from Nov 2014 to October 2015. The cases fulfilling criteria as AKI, as per definition were included in study. The urine output was monitored, base line blood urea and serum creatinine was estimated at admission and on alternate days till recovery. Investigations were done to know exact etiology of prerenal, renal or post renal AKI. Cases were managed accordingly and short term outcome was noted.Results: Out of 150 cases studied, 87(58%) were boys and 63(42%) were girls.  Ninety three cases (62%) had oliguria and remaining patients had non-oliguric AKI. Majority of cases in the study belonged to prerenal AKI, followed by renal and post renal AKI. Amongst 150 cases,136 children managed conservatively,11 cases required hemodialysis and 3 cases peritoneal dialysis. In our study, 16 cases succumbed with mortality of 10.66%.Conclusion: AKI is common associated condition in children admitted to PICU. AKI is commonly seen with acute gastroenteritis with severe dehydration, sepsis, glomerulonephritis and dengue shock syndrome. Most of these conditions are easily preventable. Early and effective management of hypovolemic shock and sepsis is also crucial in prevention of AKI.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193737
      Issue No: Vol. 6, No. 5 (2019)
       
  • A six years prospective epidemiological study of acute encephalitis
           syndrome among children admitted in a rural tertiary care center

    • Authors: Debadyuti Datta, Balai Ch. Karmakar
      Pages: 2125 - 2131
      Abstract: Background: Acute Encephalitis Syndrome (AES) is a major public health issue in India. The common etiologies of AES in India are various infectious agents. There are seasonal and regional variations in etiologies making diagnosis and effective intervention often difficult. Our study represents the epidemiological data that will help in planning management in larger perspective.Methods: This is a six years prospective observational study conducted in the Department of Pediatrics, North Bengal Medical College Hospital, Darjeeling from January 1st, 2013 to December 31st, 2018. In this study all clinically diagnosed AES cases were included fulfilling inclusion and exclusion criterion.Results: 585 out of 39420 patients (1.48%) were diagnosed clinically as AES over six years. Male patients (372) contributing to 63.6% and female patients (213) 36.4% of the study. Majority cases (271) were seen in the age group of 1-5 years amounting to 46.3% with mean age 5.1±3.6 years. In July 2014 number of cases were maximum 59 (10%) followed by May 2013 20 (3.4%). Among the 585 AES cases, 263 (45%) were suspected for viral etiology (JE= 84, 14.3%). Total 457 cases (78.1%) were alive with insignificant to age and gender variance. Vaccination status revealed 11 among 15 JE deaths were unimmunized which is statistically significant (p < 0.05) by Chi-square test.Conclusions: The magnitude and etiologies of AES need to be explored and understood in various geographic regions and in different seasons to have a better insight for development of future policies to reduce the burden.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193738
      Issue No: Vol. 6, No. 5 (2019)
       
  • Knowledge and attitude of mothers regarding feeding practices among
           children of 6 months to 2 years of age visiting a tertiary care centre of
           Ahmedabad, Gujarat, India

    • Authors: Rutvik H. Parikh, Jayshree N. Tolani, Nitinkumar D. Shah
      Pages: 2132 - 2136
      Abstract: Background: India is facing a grave challenge of having very high rates of child under-nutrition and a high infant and child mortality, which demands an urgent need for comprehensive multi-pronged evidence based strategy to tackle the situation. Breastfeeding offers the ultimate food during the first 6 months of life. Complementary feeding starts when breast milk is no longer sufficient by itself, the target age is between 6-24 months. Complementary feeding plays critical role in bridging these gaps between nutritional requirements and growth and development of child with increasing age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review we analyzed knowledge and attitude of mother regarding feeding practices among children of 6 months to 2 years of age who had visited tertiary care centre.Methods: Personal interview of mothers having a child in the age group of 6 months to 2 years of age in the duration of October 2017 to March 2018 visiting pediatric department at a tertiary care centre and willing to give information are included in the sample. The Questions regarding socio demographic profile, various occupations, type of feeding practiced, knowledge regarding feeding and complimentary feeding were included in Performa. Data was entered in MS Excel and analyzed using SPSS software.Results: Almost 8 out of 10 mothers were literate in the study (77.80%). About 75% mothers didn’t know the correct type of complimentary feeding to initiate for their babies. Knowledge about correct time of starting complimentary feeding was more commonly found in housewife mothers than the working mothers and findings was supported by statistical significance. Mothers with >=2 children were using correct type of food for complementary feeding more commonly that with mothers having single child.Conclusions: The present study highlighting knowledge gap and practice gap in mothers about complimentary feedings. Appropriate complementary feeding education emphasizing timely initiation and meal diversity is necessary to improve knowledge and feeding practices of mothers whether mother is educated or uneducated.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193739
      Issue No: Vol. 6, No. 5 (2019)
       
  • Effectiveness of case scenario-based learning over didactic lectures on
           teaching pediatric infectious diseases to undergraduate medical students

    • Authors: Rehna T., Robin Joseph Abraham
      Pages: 2137 - 2142
      Abstract: Background: Case scenario based learning offers an interactive approach in medical education. It can be either as case based or problem based. objectives of  This study compared the effectiveness of Case scenario based learning (CBL) over didactic lectures (DL) among final year part II M.B.B.S students. It also compared the student’s perception between the two methods.Methods: This interventional study was done in the Department of Pediatrics, Al- Azhar Medical College, Kerala for a period of two months. The participants(n=120) were divided into two groups- A and B who had respectively attended three sessions of CBL and DL on Pediatric infectious diseases. A test was conducted at the end of each session and after 2 weeks in the form of SAQs. A questionnaire was given to the participants about their perception. The data was analysed in SPSS 16 using unpaired t test and Mann- Whitney U test.Results: The mean exam scores for immediate tests were 26.04±1.9 and 19.47±2.8 for Batch A and Batch B respectively. The mean exam scores for the test conducted after two weeks showed significant result with 24.0±2.56 and 18.58±4.03 for Batch A and B respectively. Comparison of student’s perception on Likert’s scale about the teaching method yielded significant difference for CBL over DL with p<0.001.Conclusions: Case scenario based learning is an innovative method which is sure to invoke more interest and academic excellence in medical students.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193740
      Issue No: Vol. 6, No. 5 (2019)
       
  • Hypertonic saline and adrenaline nebulization in the treatment of
           bronchiolitis: a retrospective study

    • Authors: Poornima Shankar, Jayalalitha S. Marol, Akash B. K.
      Pages: 2143 - 2146
      Abstract: Background: Bronchiolitis is the leading cause of acute illness and hospitalization in young children. There is limited role for diagnostic laboratory or radiographic tests in typical cases of bronchiolitis. Several large recent trials have revealed lack of efficacy of either bronchodilators or corticosteroids. Novel treatment like hypertonic saline and adrenaline nebulizations need to be evaluated for their efficacy.Methods: In this retrospective case control study, we included children aged between 6 months to 2 years admitted for bronchiolitis between August 2017 till July 2018. Each of the 45 children treated with adrenaline nebulisation was assigned a child who was given hypertonic saline nebulization only matched for age and duration of symptoms.Results: 45 children given adrenaline nebulization and 45 children given only hypertonic saline nebulization were compared. Mean duration of stay for children treated with adrenaline nebulization was 5.3 days and those given hypertonic saline was 4.8 days.  p value of 0.29.Conclusions:  Adrenaline nebulization did not shorten hospital stay in children admitted for bronchiolitis as compared to children given hypertonic saline.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193741
      Issue No: Vol. 6, No. 5 (2019)
       
  • Outcome analysis of a newly setup pediatric intensive care unit in a
           teaching hospital of northern India

    • Authors: Aparna Chakravarty, Jagannath Mohapatra, Richa Garg, Shaurya Kumar
      Pages: 2147 - 2151
      Abstract: Background: Pediatric intensive care units (PICU) have brought about dramatic increase in the survival of critically ill children. The aim of pediatric intensive care is not just to save lives but also to maximise the quality of those lives. Evaluation of the outcome of an intensive care unit is necessary as a measure of quality improvement in patient care.Methods: A retrospective observational study was done in a PICU of a teaching hospital between February 2017 to August 2018. Records of all admissions, transfer outs, discharges and deaths were collected along with age, sex, diagnosis, length of stay, and outcome.Results: Mean age of the 601 patients admitted over a period of nineteen months was 4 years. 36% patients were between 1-5 year and 32% were infants. Major indication for admission to the PICU was respiratory (30%) followed by neurological illnesses (25%) and infections (22%). Increased length of stay (LOS) (>5 days) was seen in respiratory, neurological diseases and infections. A significant relation (p value <0.05) was found between outcome and patients admitted with sepsis and the group classified as others. Patients admitted with involvement of nephrology system had a significant relation with LOS (p value <0.05). The mortality rate was 2%.Conclusion: The outcome analysis of our newly setup PICU is comparable with other studies in the Indian subcontinent. Active surveillance or audit of PICU admissions help capture lapses in management and bring a better outcome with available resources.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193742
      Issue No: Vol. 6, No. 5 (2019)
       
  • Evaluation of thyroid nodule in pediatric population in a tertiary care
           hospital

    • Authors: Mukul Singh, Manju Kumari
      Pages: 2152 - 2155
      Abstract: Background: Thyroid nodules are commonly present in adult population but are rare in pediatric age group. Inspite of being rare, thyroid nodule have a higher chance of malignancy in children. Thus, pediatric patients presenting with thyroid nodule found clinically or incidentally should be worked up to rule out any possibility of malignancy. The besthesda system for reporting thyroid cytopathology (TBSRTC) is widely used for reporting in adults. The present study aims to use TBSRTC for pediatric thyroid lesions reporting.Methods: All pediatric patients with age ≤ 18 years presenting with thyroid nodule during January 2018 to April 2019 were included in the study, fine needle aspiration (FNA) was done and findings were compared with histology. Statistical analysis was done using SPSS version 18.Results: 42 pediatric patient were included in the study, out of which 2.38% were malignant and suspicious for nmalignant each and 83% were benign.Conclusion: TBSRTC is quite sensitive and specific reporting guideline in pediatric population as in adult population with 100% accuracy in diagnosing benign and malignant cases. This is useful for avoiding unnecessary surgeries.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193743
      Issue No: Vol. 6, No. 5 (2019)
       
  • A cross-sectional study of behavioural disorders in children with human
           immunodeficiency virus / acquired immuno deficiency syndrome attending an
           anti-retroviral therapy centre

    • Authors: Prashantha Kumar G., Kumaravel K. S.
      Pages: 2156 - 2161
      Abstract: Background: HIV is a chronic disease which also significantly affects the behavior. This study aims at evaluating behavioral disorders in children with HIV/AIDS.Methods: This Cross-sectional study utilized the Child Behaviour Check List.Results: The overall prevalence of borderline and clinically significant behavioral problems were 69.3% (n=104). The prevalence of behavioral disorders were observed in the eight categories - anxious/depressed (borderline-7.7%, clinically significant-18.3%), withdrawn/depressed (6.7%, 18.3%), somatic problems (7.7%, 6.7%), rule-breaking behavior (7.7%, 18.3%), aggressive behavior (10.6%, 21.1%), attention problems (15.4%, 2.9%) and thought problems (9.6%, 2.9%). No social problems were observed. Internalizing problems were common in girls and externalizing problems were common in boys. As age advanced a simple linear progression in prevalence of Behavior Problems was found. There were 47.1% of Orphans in study and behavioral problems were more common in them.Conclusions: High prevalence of behavioural abnormalities warrants comprehensive management including Behavioural counselling and therapy and not just drugs for these children.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193744
      Issue No: Vol. 6, No. 5 (2019)
       
  • Efficacy of levetiracetam as the first line anti- epileptic drug in
           management of neonatal seizures

    • Authors: Kaushik Ragunathan, Jayakumar Chandrasekhar
      Pages: 2162 - 2168
      Abstract: Background: Neonatal seizure management has not changed much in the last 50 years. Neuronal apoptosis in animal models and cognitive impairment in human subjects has been reported with the use of Phenobarbitone. Levetiracetam is advantageous as it is effective, well tolerated and has least drug interactions.Methods: This double blinded, randomized, parallel group, active controlled study was conducted among 66 neonates in the Neonatal intensive care unit of a tertiary care hospital for a period of 18 months. Neonates with seizures fulfilling the inclusion criteria were treated either with Phenobarbitone or Levetiracetam. Seizure control was defined as no seizure activity within 40 minutes of the administration of the first drug. Failure of first line agent was treated with Phenytoin. Neonates were observed for a period of 14 weeks for recurrence of seizure and any serious adverse effects.Results: Effective seizure control was achieved in 64.7% neonates in Levetiracetam group as compared to 31.2% in Phenobarbitone group (p <0.05). Early resumption of breast feeds within 6 hours of therapy was achieved in 73.5% neonates treated with Levetiracetam compared to 31.2% neonates treated with Phenobarbitone (p value = 0.001).Conclusions: Levetiracetam is a promising alternative as first line Anti-epileptic drug in neonates with seizures. Prolonged sedation was the adverse effect noted to Phenobarbitone that made breast feeding and neuro- assessment difficult. No serious adverse effects were seen with Levetiracetam.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193745
      Issue No: Vol. 6, No. 5 (2019)
       
  • Status of trace elements zinc, copper, and selenium in transfusion
           dependent beta thalassemic Indian children: a cross sectional study

    • Authors: Babulal Choudhary, Anurag Singh, Vishnu K. Goyal, Pramod Sharma, G. S. Totetja, Vikas Payal, Zaozianlungliu Gonmei
      Pages: 2169 - 2172
      Abstract: Background: Maintenance of normal levels of copper, selenium, and zinc play an important part in lessening the morbidities associated with thalassemia major. Levels of these elements have been found to be altered in this chronic transfusion dependent disease from all over the world, but with widely variable results.  Besides repeated blood transfusions and use of chelating agents, their levels in thalassemics are affected by genetic and dietary factors also, compelling us to undertake this study in our population. The Objectives of this study was to assessment of serum levels of zinc, copper and selenium in transfusion dependent beta thalassemics.  Methods: Cross sectional descriptive study conducted at Thalassemia Day-care Centre of a teaching hospital. Total 64 transfusion dependent thalassemics in the age group 3-18 years were subjected to serum levels of zinc, copper and selenium by inductively coupled plasma mass spectrometry technique.   Results: Four (6.25%) had hypozincemia, 15 (23.43%) hypocupremia and one (1.565%) had hypercupremia. Two (3.12%) had higher selenium levels (>190 µgm/l).Conclusions: In contrast to previous studies, hypocupremia has been found to be more prevalent than hypozincemia and hyposelenemia in our population. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193746
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinical usage of intravenous immunoglobulin in neonates in a tertiary
           care centre: a retrospective observational study

    • Authors: Sharath S. Ghalige, Vaideeswaran M., Mangalabharathi S.
      Pages: 2173 - 2177
      Abstract: Background: Intravenous Immunoglobulin (IVIG) is a blood product manufactured from pooled plasma. With increasing availability, an increased usage in neonates is being noted, though its utilisation has not been audited thoroughly. The objectives of this study are to describe the usage pattern and indications of IVIG and its outcome in a state-run tertiary care NICU.Methods: This retrospective observational study was carried out at the inborn unit of Department of Neonatology, Madras Medical College, Chennai on a cohort of neonates who received IVIG over 3.5 years from January 2016 to June 2019. Data was collected from drug register, neonatal case records, exchange transfusion register and death register.Results: Our study cohort had 55 neonates who received IVIG over 3.5 years. Indications for IVIG usage were Rh-alloimmunisation (23), ABO-alloimmunisation (7), prophylaxis of perinatal varicella (20), and other immune thrombocytopenia (5). Among 30 neonates with ABO-/Rh-incompatibility, 11 required exchange transfusion (ET). ET rates have shown a decreasing trend during this period. 2 babies with Rh-immunisation and Hydrops expired. None of the babies given prophylaxis for perinatal varicella manifested the disease. Neonates treated for immune thrombocytopenia were successfully discharged.Conclusions: This study shows the IVIG usage pattern in a tertiary care neonatal unit. In neonates with Hemolytic disease due to Rh-/ABO-alloimmunisation treated with IVIG, a reduction in rates of exchange transfusion has been noted. IVIG is being used increasingly for prophylaxis of perinatal varicella and immune related thrombocytopenia with promising benefits. It is prudent to have SOPs for IVIG administration with standardised issue and transfusion forms for documentation to regulate its judicious use. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193747
      Issue No: Vol. 6, No. 5 (2019)
       
  • Clinical profiles and outcomes of neonates with neonatal
           hyperbilirubinemia and treated with double volume exchange transfusion: a
           retrospective study

    • Authors: Janaki Ballav Pradhan, C. N. Kamalarathnam
      Pages: 2178 - 2183
      Abstract: Background: Double volume exchange transfusion (DVET) for severe unconjugated hyperbilirubinemia has become less common events now days in pediatric practices. But kernicterus is still common in low income country like India. The aim of the study was to determine the clinical profile and outcome in neonates who were treated with DVET.Methods: This was a retrospective study in neonate’s ≥34 weeks of gestation that were treated with DVET for severe neonatal hyperbilirubinemia over a period of four years.Results: In our study, 37 neonates underwent DVET. Male neonates (62.13%) and normal vaginal delivery (NVD) (70.2%) are common. ABO Isoimmunisation was commonest cause (56.75%) of exchange transfusion.  The mean TSBR at pre exchange and Post Exchange were 27.39 ± 5.99mg/dl and 15.16 ± 4.00mg/dl (p<0.05). Ten neonates (27%) among 37 neonates required twice DVET.Thrombocytopenia14 (37.83%); Seizure 5(13.5%) and Hypocalcaemia 3(8.1%) were common complication noted among total 17 (45.94%) neonates. BIND occurred in 15 neonates (40.5%) at the time of admission and seven (18.9%) neonates had persistent neurological abnormality at discharge. Neonate with BIND had early onset of jaundice (44.13±15.37 hours vs. 61.22±28.23hrs, p<0.05), with  higher  pre exchange TSBR value(28.96 ±8.5mg/dl vs. 26.22±3.17mg/dl). Neonates admitted with BIND had higher percentage of persistent encephalopathy (40% vs. 4.5%,p<0.05), abnormal tone (33.3% vs. 4.5%,p<0.05), abnormal feeding (33.3% vs. 4.5%,p<0.05) and abnormal posture (26.6% vs. 0%,p<0.05)  at discharge as compared to those without BIND. No death occurred in this study population.Conclusions: Early detection and aggressive therapy with DVET can prevent neonates from brain injury.   
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193748
      Issue No: Vol. 6, No. 5 (2019)
       
  • Effectiveness of Module Based Learning regarding Facility Based Newborn
           Care in terms of knowledge and practices among nursing students

    • Authors: Minal Kumari, Yogesh Kumar, Parvinder Kaur
      Pages: 2184 - 2188
      Abstract: ABSTRACTBackground: Mobile Applications are being developed at a rapid speed and are intensively used by students. It can help to achieve better performance in organizing, managing, and monitoring classroom activities.Aims and objectives: Present study aimedto assess and compare the knowledge and practice regarding FBNC among nursing students in MBL group and MABL group before and after the administration of MBL and MABL. The conceptual framework of the study was based on CIPP model by Stufflebeam.Methods: A Quantitative research approach with quasi-experimental and  non-equivalent controlgroup pre–test post–test design. The study was conducted at two nursing colleges of Ambala, Haryana. A total of 70 B.Sc. Nursing 3rd Year students, randomly allocated to 2 groups i.e. 35 in MBL and 35 in MABL. The tool used for the study consisted of structured knowledge questionnaire and observational check list was used to assess knowledge and practices by OSCE method of nursing students regarding FBNC. Data collection was done in January, 2017. The obtained data was analyzed and interpreted in terms of objectives and researchResults: Findingsof the study indicate that revealed that mean post- test knowledge and practices score in MBL group (21.4 ±0.89) and in MABL group (22.4 ± 0.54) was significantly higher than pre-test knowledge score in MBL group (14.6±15.0) and in MABL group (16.2±17.0). Also, the mean post-test practice score in MBL group (38.1±1.91) and in MABL group (38.9± 1.20) was significantly higher than pre-test practicescore in MBL (20.4 ± 3.70) as well as in MABL group (20.5 ± 4.26). Mild positive significant relationship (r=0.03) was found between post test score of knowledge and practicesConclusion: MABL was more effective in developing the practices of nursing students regarding FBNC than MBL.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193749
      Issue No: Vol. 6, No. 5 (2019)
       
  • Public awareness towards first aid management of epilepsy

    • Authors: Chaitra K. M., Avinash Agrawal, Varshini P., Anil H., Sweta Athani
      Pages: 2189 - 2192
      Abstract: Background: Determination of attitude and awareness towards epilepsy in general population. Despite successfully achievement of management of epilepsy in hospitals, the efforts to assess the awareness and mass education is very limited.Methods: Total 880 participants were required to answer a series of questionnaires related to demographic data, awareness, attitude towards epilepsy with details of their first aid management and their source of information for the same.Results: Concerning attitude, 14.65% would object having their children associated with epilepsy. 72.16% would object to marry or their children marrying an epileptic. 8.86% thought epilepsy as a form of insanity. Concerning knowledge, the 33% will seek others help as a first aid measure and 50% don’t have any source of information regarding first aid management.Conclusions: The results indicate considerable amount of social stigma still exist and alarming fact was even the educated people still think it as a social stigma and are biased. Awareness needs to be enhanced through various knowledge campaigns. Stress on proper first aid measure to a seizing person needs to be addressed to remove fear and anxiety among the public.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193750
      Issue No: Vol. 6, No. 5 (2019)
       
  • Role of maternal Anemia on cord hemoglobin and infant hemoglobin and
           ferritin level at nine months of age

    • Authors: Abu Sadique, Achinta K. R. Mallick
      Pages: 2193 - 2197
      Abstract: Background: Primary objective was to compare hemoglobin at 9 months and secondary objective was to compare birth weight, cord hemoglobin and serum ferritin at 9 months between infants born to anaemic and non anaemic mothers.Methods: In this prospective cohort study, we compared cord hemoglobin, birth weight, hemoglobin at 09 months & serum ferritin at 09 months in infants of anaemic and non anaemic mothers.  Subject of the study was all inborn term infants (n = 344).Results: Cord blood hemoglobin was similar between infants born to anaemic and non anaemic mothers. However, infants born to anaemic mothers weighed less at birth and had lower hemoglobin at 9 months of age.Conclusions: Infants born to anaemic mothers are at higher risk of developing anaemia in late infancy which may remain undetected at birth.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193751
      Issue No: Vol. 6, No. 5 (2019)
       
  • Antenatal diagnosis of alobar holoprosencephaly: a case report

    • Authors: Manjushri Waikar, Anamika Singh
      Pages: 2198 - 2202
      Abstract:  Holoprosencephaly (HPE) is a structural malformation of the brain that results from the complete or incomplete noncleavage of the forebrain/ prosencephalon of the embryo into 2 hemispheres1. We present a case of twenty-five year-old primigravida presented to the Outpatient department of Obstetrics for routine checkup and diagnosed with Alobar holoprosencephaly on 2nd level USG. Fetal MRI was performed and the findings were confirmed. Even though ultrasonography is diagnostic in the detection of fetal anomalies, MRI plays a vital role due to its multiplanar capability and excellent soft tissue resolution. The purpose of publishing this case is to sensitize the clinicians to the classical features of holoprosencephaly on various imaging modalities and to stress the importance of its detection before 20 weeks of gestation so as to allow for legal medical termination and alleviate maternal psychological trauma of bearing a deformed fetus.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193736
      Issue No: Vol. 6, No. 5 (2019)
       
  • Congenital chylous ascites: a case report

    • Authors: Rajsree Sreedevi, Jose Paul, George Jose, Abdul Majeed
      Pages: 2203 - 2205
      Abstract: Due to the rarity of congenital chylous ascites and the lack of standards in diagnosis and therapy, this disease constitutes a medical challenge and individual therapy seems to be extremely important. A late preterm newborn with antenatally diagnosed ascites was born and chylous ascites was diagnosed after feeds were started. The baby was managed initially with nil per oral, parenteral nutrition and octreotide, followed by adding MCT formula feeds. Considering the rarity of neonatal chylous ascites and the non-uniformity in management plans and follow up, more case reports need to be published. Also, MCT formula, the main stay of management has to be discontinued as soon as possible with gradual introduction into breast feeds or normal newborn formula milk as long chain fatty acids are essential for optimal brain growth in newborns. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193699
      Issue No: Vol. 6, No. 5 (2019)
       
  • A rare case of Poland: Mobeius syndrome in an infant

    • Authors: Arohi Gupta
      Pages: 2206 - 2208
      Abstract: Mobius syndrome is a rare condition of unclear origin, characterized by a unilateral or bilateral congenital facial weakness with impairment of ocular abduction, which is frequently associated with limb anomalies. Poland Syndrome is a rare condition that is evident at birth (congenital). Associated features may be extremely variable from case to case. However, it is classically characterized by absence (aplasia) of chest wall muscles on one side of the body (unilateral) and abnormally short, webbed fingers (symbrachydactyly) of the hand on the same side (ipsilateral). In those with the condition, there is typically unilateral absence of the pectoralis minor and the sternal or breastbone portion of the pectoralis major. In females, there may be underdevelopment or absence (aplasia) of one breast and underlying (subcutaneous) tissues. In some cases, associated skeletal abnormalities may also be present, such as underdevelopment or absence of upper ribs; elevation of the shoulder blade (Sprengel deformity); and/or shortening of the arm, with underdevelopment of the forearm bones (i.e., ulna and radius). Other associated abnormalities may include dextrocardia, diaphragmatic hernia and renal anomalies etc. Poland Syndrome affects males more commonly than females and most frequently involves the right side of the body. The exact cause of the condition is unknown. The combination of Poland-Mobius syndrome is rare, with an estimated prevalence 1:500 000. 
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193151
      Issue No: Vol. 6, No. 5 (2019)
       
  • A rare case of Vitamin D dependent rickets type II: a case report

    • Authors: Raghava Badabagni, Rambabu Bodduluri, P. V. Prudhvi Raju
      Pages: 2209 - 2211
      Abstract: Vitamin D-dependent type II rickets (VDDRII) is a rare autosomal recessive disorder caused by mutation in the vitamin D receptor gene, leading to end-organ resistance to 1,25(OH)2 vitamin D3. It presents with refractory rickets and growth retardation presenting in the first year of life. It is frequently associated with alopecia totalis. Due to target organresistance, its response to vitamin D is poor. The recommended treatment is giving supra physiological dose of 1,25(OH)2 vitamin D3 and a high dose of oral or intravenous calcium. The response of alopecia to treatment is generally poor. We present a 3 ½ year-old male child with VDDR II whose alopecia and rickets partially responded to 1,25(OH)2 vitamin D3.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193753
      Issue No: Vol. 6, No. 5 (2019)
       
  • Salmonella liver abscess: an unusual complication of typhoid fever with
           hepatitis: a coinfection

    • Authors: Tonyot Gailson, Sadbhavna Pandit
      Pages: 2212 - 2214
      Abstract: Typhoid fever continues to be a major cause of mortality and morbidity particularly in children and adolescent in developing countries due to poor sanitation and lack of safe drinking water facilities.Even in antibiotic era, complications of typhoid fever continue to be a common problem due to many factors like inadequate treatment, delayed presentation, drug resistance and associated morbidity. Hepatic involvement in typhoid fever is common in children, but liver abscess due to Salmonella species is rare. We hereby present a case of a 5-year-old Indian female child who was initially managed as acute viral hepatitis (hepatitis-A IgM positive). However, persistence of fever and pain abdomen led to the diagnosis of liver abscess on ultrasound. Blood culture and aspirate of the abscess grew salmonella typhi. She was adequately managed with intravenous antibiotics leading to complete resolution of the abscess.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193754
      Issue No: Vol. 6, No. 5 (2019)
       
  • A case of moyamoya disease in a patient with multi-drug resistant
           tuberculosis

    • Authors: Kedar M. Tilak, Sandhya V. Haribhakta
      Pages: 2215 - 2218
      Abstract: Moyamoya cerebral angiopathy is characterized by progressive stenosis or occlusion of the internal carotid artery or its branches with subsequent development of basilar collaterals. It is commonly seen in Asian population.
      Authors present a case report of a 12 year-old boy with Multidrug resistant tuberculosis with Moyamoya disease. Moyamoya disease rarely coexists with tuberculosis. However, we can infer that tuberculosis may coexist in a patient in a patient of Moyamoya disease.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193755
      Issue No: Vol. 6, No. 5 (2019)
       
  • Osteogenesis imperfecta: a case report

    • Authors: Kambiakdik T., Inderpreet Sohi, Toli Nyorak, Pawam Kumar Kumar, Sengseng R. Sangma, Zosangliani .
      Pages: 2219 - 2221
      Abstract: Osteogenesis imperfecta (OI) is a group of rare inherited disorders of connective tissue with the common feature of excessive fragility of bones caused by mutations in collagen. Diagnosis is mainly based on the clinical features of the disorder. We report a late preterm a male neonate born to a 20 years old primigravida. He had clinical features of a type II OI and severe birth asphyxia.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193756
      Issue No: Vol. 6, No. 5 (2019)
       
  • Role of oral sildenafil in neonates with persistent pulmonary hypertension
           of newborn

    • Authors: Arohi Gupta, Mala Kumar, Tarun Anand
      Pages: 2222 - 2224
      Abstract: Persistent pulmonary hypertension of newborn is a devastating condition and leads to morbidity and mortality. Even after the increasing use of  NO, ECMO and HFO many patients succumb to death. About 50% of the patients either have rebound hypertension or do not respond to the treatment. Hence the role of phosphodiesterase inhibitors (sildenafil) need to be evaluated. Methods is authors report a retrospective case series of 24 patients with PPHN admitted in NICU and treated with oral sildenafil. Results sildenafil was started on all patients on a mean of 1.46 days and stopped on mean of 3.8 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 50% on mean of 10 days. Average length of stay in NICU was 20 days. 17(70.8%) patients survived whereas 7 (29%) expired No improvement in oxygen Index after 48 hours (p<0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusion are oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193757
      Issue No: Vol. 6, No. 5 (2019)
       
  • Paroxysmal hypertension with reversible posterior leukoencephalopathy
           syndrome in a child: an unresolved riddle

    • Authors: Mili Thomas, Veena V. Nair, Lekha Hrishikesan, Kamala Swarnam
      Pages: 2225 - 2227
      Abstract:  Nine year old girl was presented with paroxysmal episodes of hypertensive emergency. She was asymptomatic with normal blood pressure without antihypertensives in between the episodes. MRI brain was suggestive of reversible posterior leukoencephalopathy.  Acute episodes were managed with IV labetalol infusion and amlodipine. She was evaluated extensively to find out the etiology of hypertension. Cardiac and renal causes were ruled out. Work up for pheochromocytoma, hyperaldosteronism, porphyria and vasculitis were negative. The case is reported in view of the rare presentation and the leukoencephalopathy noted in this case.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193758
      Issue No: Vol. 6, No. 5 (2019)
       
  • Atypical presentation of congenital diaphragmatic hernia: case report

    • Authors: Sunita Arora, Gurpreet Kaur
      Pages: 2228 - 2230
      Abstract: The Congenital diaphragmatic hernia generally presents with severe respiratory distress in the neonatal period and usually occurs once in every 2,000-3500 births. Late-presenting congenital diaphragmatic hernia (CDH) has been defined as CDH diagnosed after the neonatal period due to initial symptoms after the neonatal period or asymptomatic CDH found in the course of routine X-ray examination of the chest beyond the neonatal period. When late presentations occur, patients may be asymptomatic or may be critically ill with unusual respiratory and gastrointestinal symptoms. Case characteristics: 3yrs old female child presented with history of pain abdomen, abdominal distension, vomiting, respiratory distress and fever since 5days. Chest tube was inserted in view of left sided pleural effusion. Later on, diagnosed with diaphragmatic hernia. Outcome Child was operated, and diaphragmatic repair done and was discharged successfully after 38 days. Message: Congenital diaphragmatic hernia should be considered in the differential diagnosis of any child with unusual respiratory or gastrointestinal symptoms and abnormal chest radiographic findings.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193759
      Issue No: Vol. 6, No. 5 (2019)
       
  • Bili blanket phototherapy

    • Authors: Jissa Donel
      Pages: 2231 - 2234
      Abstract: Jaundice is a common condition in neonates, occurring in 60% to 84% of late term and term  infants. Phototherapy is considered as a treatment of choice since many years in the management of unconjugated hyperbilirubinemia. Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. Treatment with phototherapy is implemented in order to prevent the neurotoxic effects of high serum unconjugated bilirubin. Different types of phototherapy delivery system are in use. Bili blanket phototherapy uses fiberoptic systems  that reduces or eliminates all of the potential complications of conventional phototherapy and  facilitates establishment of  an enhanced parent-infant bond.
      PubDate: 2019-08-23
      DOI: 10.18203/2349-3291.ijcp20193760
      Issue No: Vol. 6, No. 5 (2019)
       
 
 
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