Role of line probe assay in detection of Mycobacterium tuberculosis in children with pulmonary tuberculosis.

BACKGROUND: India is the highest TB burden country in the world with almost 27 lakh cases reported in 2019. Pediatric tuberculosis in India accounts for almost 31% of global TB burden. Despite such high mortality and morbidity in children, diagnosis of pulmonary TB in children still remains very challenging. MATERIAL AND METHODS: This cross-sectional study was conducted in a tertiary care hospital in Delhi, India. Children between 1 and 12 months with clinical suspicion of pulmonary tuberculosis who had not previously taken ATT were included. Early morning gastric aspirate samples were collected after overnight fasting, on two days. Both days sputum sample were subjected to sputum smear microscopy and one of the two samples was subjected to line probe assay (LPA), cartridge based nucleic acid amplification (CBNAAT) and mycobacterium growth in tube (MGIT-960). RESULTS: 84 children with pulmonary tuberculosis were enrolled. The most common presenting complaint was fever seen in 83 patients (98.8%). Only 17 (20.24%) were sputum smear positive by Ziehl- Neelsen (ZN) staining. LPA was positive in 47 (55.95%) samples and among these positive samples both INH and RIF resistance was detected in 2 (4.26%) samples. CBNAAT was positive in 53 patients (63%). Growth in liquid culture media (MGIT 960) was observed in 44 (52.38%) samples. Among 17 smear positive samples, LPA was detected in 14 (82.35%) samples and among 67 smear negative sample LPA was detected in 33 (49.25%) samples. LPA had 63.46% sensitivity, 100% specificity in detecting mycobacterium tuberculosis. DISCUSSION: WHO's recommendation for using LPAs has been limited to culture isolates or smear-positive sputum specimens. New data has since been generated on the use of LPAs as newer versions of LPA have been developed over past few years. Previous studies conducted using LPA version 1.0 reported much lower detection rate of mycobacterium tuberculosis in smear negative specimens. With the availability of newer versions such as Hain GenoTypeMTBDRplusversion 2 and Nipro NTM + MDRTB detection kit 2, the diagnostic utility of LPA may be enhanced.

Efficacy and Safety of Low Dose Insulin Infusion against Standard Dose Insulin Infusion in Children with Diabetic Ketoacidosis- An Open Labelled Randomized Controlled Trial.

Objective: To compare the efficacy and safety of low dose insulin infusion (0.05 U/kg/h) against the standard dose insulin infusion (0.1 U/kg/h) in children with diabetic ketoacidosis. Method: Children (age <12 years, n = 30) presenting with diabetic ketoacidosis were enrolled and randomised to receive insulin infusion either as 0.05 U/kg/h (low dose) or 0.1 U/kg/h (standard dose) as an open labelled randomised controlled trial. The rest of the management was identical in both groups. The time taken for resolution of acidosis (pH ≥7.3 and HCO3 ≥15) was the primary outcome variable. The secondary outcome variables included the time taken until a decline in blood glucose to 250 mg/dl, the proportion of children developing hypoglycemia and hypokalemia, and any treatment failure. Results: The two groups were similar with respect to mean age, weight and gender distribution. New-onset diabetes was diagnosed on 24/30. The mean ± SD time for resolution of acidosis was similar between the groups; 27.0 ± 6.1 hours in the low dose group vs 23.4 ± 7.3 hours in standard dose group, P = 0.16. The mean time for the decline in blood glucose to 250 mg/dl was 13.0 ± 5.9 hours in low dose vs 11.6 ± 6.0 hours in standard dose group, P = 0.52. A lesser proportion of participants developed hypoglycemia and hypokalemia in the low dose group, though not statistically significant. There was no incidence of treatment failure in either group. Conclusion: Low dose insulin infusion is equally effective and safe as standard dose insulin infusion in children with diabetic ketoacidosis.

Effect of Kangaroo Mother Care on Duration of Phototherapy on Neonatal Jaundice: A Randomized Controlled Trial.

Neonatal hyperbilirubinemia (NNH) is a common morbidity in the neonatal period, especially in the preterm and low-birth-weight babies. Low-birth-weight babies receiving phototherapy do not receive kangaroo mother care (KMC), which may hamper their weight gain and establishment of breast-feeding. The authors investigated the effect of KMC on duration of phototherapy in neonates admitted to a level III nursery with neonatal hyperbilirubinemia. Fifty neonates with gestational age of 30 to 40 wk, birth weight 1001-1999 g, and requiring phototherapy were randomized. Control group received phototherapy in a conventional manner. The intervention group received KMC for 1 h every 8 hourly. The mean (± SD) of total duration of phototherapy required in control group and in KMC group was 39.12 ± 15.3 and 19.44 ± 6.54 h, respectively and this difference was statistically significant.

Sleep Studies in Children.

Sleep-related breathing disorders (SRBD), also referred to as sleep-disordered breathing (SDB), are common sleep disorders in children. They can be broadly divided between central and obstructive sleep-disordered breathing with or without associated hypoventilation. In most cases, SRBD are associated with adenotonsillar hypertrophy (obstructive SDB) which are classified as simple. SRBD can co-exist with an underlying condition like obesity, genetic syndromes or neuromuscular disorders which are classified as complex. Polysomnography (PSG) is the gold standard for diagnosing sleep disorders. However, it is time-consuming and requires trained technician to acquire and interpret signals. Attended in-lab respiratory polygraphies are easier to conduct and provide respiratory data equivalent to a PSG. Similar to adult sleep services, overnight unattended home respiratory polygraphies are becoming more widely used. These require careful patient selection and good parental education programs to be most successful in children. Overnight oximetry has limitations but can be a useful tool for screening children with obstructive sleep apnea and prioritizing treatment. This review aims to discuss these various diagnostic methods to assess sleep disorders in children.

Global Strategy on Digital Health.

Digital technology has been a revolutionary foray in education, industry, research and recently, healthcare. Digital health encompasses various aspects of technology like information and communication, mobile health, data-recording and telemedicine. There has been an exponential and unregulated increase in digital health services in last few years which have raised concerns over data privacy, ethical standards and quality of services. The World Health Organization recently released the global strategy on digital health as a visionary document that provides a framework for countries to implement and expand digital health services. The following update briefly highlights the salient features of the update.

Maternal knowledge, attitude and practices during childhood diarrhoea.

Diarrhoea and pneumonia account for most deaths in children aged < 5 years. However, most diarrhoeal deaths are preventable with appropriate hygienic measures and timely initiation of rehydration therapy. A cross-sectional study was conducted on 280 mothers with children aged 2-59 months with acute watery diarrhoea at a tertiary hospital. One-fifth of respondents were illiterate and only one-third of mothers pre-treated water to make it drinkable. Mean knowledge scores for hand washing, diarrhoea prevention and complications of diarrhoea were poor, though higher in educated mothers ( P < 0.05). Scores were similar for the first episode or repeat episodes of diarrhoea. Only 50.4% and 55.2% mothers knew the correct method of Oral Rehydration Solution (ORS) preparation and administration, respectively. Lack of adequate maternal knowledge and practices concerning childhood diarrhoea highlights the need for patient counselling and education, especially among the illiterate in India.

Acute kidney injury in a child: A case of Munchausen syndrome by proxy.

Renal and urologic problems in pediatric condition falsification (PCF) or Munchausen by proxy (MSP) can result in serious diagnostic dilemma. Symptoms of hematuria, pyuria and recurrent urinary tract infections have occasionally been described. However, MSP presenting as azotemia has not been previously reported. We describe the case of an unfortunate boy who had to undergo unnecessary hemodialysis for persistent hyperkalemia and azotemia before a final diagnosis of the falsification of investigations by the parents was made.

Transient restricted diffusion of corpus callosum and subcortical white matter following febrile status epilepticus.

We describe the case of a 4½-year-old girl with prolonged febrile status followed by abnormal behavior and loss of speech. Interesting findings on diffusion-restricted imaging were noted. The clinicoradiologic possibilities are discussed.

Publication misconduct among medical professionals in India.

This study was planned as an exploratory study to determine the extent of occurrence of misconduct in publication (gift-authorship,ghost-authorship, falsification of data, fabrication of data,plagiarism, and duplication) amongst biomedical researchers.It was a questionnaire-based study, conducted at 9 institutions;6 medical colleges (4 government-run and 2 private), 7 non teaching government hospital, and 2 corporate hospitals, located in northern, central and southern India. The study was conducted between August 2072 and March 2073. 755 senior residents (<3 years after post-graduation) and young faculty members (< 70 years after post-graduation) with at least five previous publications were administered a structured questionnaire, in which no identifying information was collected. In addition to personal characteristics, the information collected included their knowledge of publication ethics, their opinions about the prevalence of these practices among their colleagues, and details of any first-hand information on publication misconduct. 7 55 responses were included for analysis. 7 4 7 (9 7 %) respondents agreed that they had some knowledge of publication ethics; but only 29% believed it was adequate. The most commonly observed misconduct was offering gift authorship, reported by 707 (65%); followed by alteration of data reported by 88 (56%). Plagiarism was observed by 83 respondents (53%); while 52 (33.5%) respondents had observed a colleague's name being omitted from a paper to which she/he had significantly contributed. A majority of respondents in the present study reported witnessing publication misconduct,thereby revealing the common occurrence of this problem among Indian biomedical researchers.

Breastfeeding.

The benefits of breastfeeding for the infant and nursing mother are well established. The World Health Organisation (WHO) recommends exclusive breastfeeding up to 6 mo and continued breastfeeding up to 2 y. Exclusive breastfeeding is the most effective intervention to reduce infant mortality and is estimated to prevent 13 % of under 5 child mortality in low income countries. However, rate of exclusive breastfeeding is alarmingly low in our country. Mothers who face problems in breastfeeding immediately resort to top feeds. It is the responsibility of the health professionals to identify and manage breastfeeding problems appropriately. UNICEF/World Health Organisation, through Baby Friendly Hospital Initiative (BFHI), have recommended good health care practices that support breastfeeding and increase likelihood of optimum breastfeeding. This paper briefly discusses breastfeeding and related feeding problems seen in clinical practice.

Johanson-Blizzard syndrome: hepatic and hematological features with novel genotype.

Johanson-Blizzard syndrome (JBS); (OMIM: 243800) presents with features of malabsorption and dysmorphic features with onset of symptoms in infantile age group. The disorder was first described in the year 1971 with report of the first Indian case in 2004. We discuss two rare phenotypes (hepatitis and anemia) in a molecularly confirmed case of JBS.

Acute renal failure in children in a tertiary care center.

In this retrospective study, records of all patients aged one month to 12 years who presented with acute renal failure (ARF) between May 2005 and August 2010 were retrieved. Clinical details, biochemistry, need for renal replacement therapy (RRT), cause of ARF and outcome at discharge were recorded. During this period, 230 children presented with ARF; their median age at presentation was 30 months (range: five-144 months); 120 (52.2%) were males. The causes of ARF were acute tubular necrosis (ATN) in 121 (52.6%), glomerular disorders in 5.7%, structural anomalies of the urinary tract in 9.6% and hemolytic uremic syndrome in 27 (11.7%). The mean duration of hospital stay was 17.8 ± 7.6 days. RRT was required for 54 patients (23.6%); peritoneal dialysis in 49 and hemodialysis in five patients. Complete recovery was noted in 99 study patients (43.2%) and sequelae remained in 84 patients (36.7%). Forty-six patients (20.1%) with ARF died. ATN secondary to septicemia was the most common cause of ARF in our study.

Unusual presentation of celiac disease presenting with renal complications.

Celiac disease is a chronic inflammatory condition of small intestine resulting due to sensitivity to wheat protein gluten. Most patients in the childhood present with primary gastrointestinal complaints. The authors present here two young girls with renal complaints later diagnosed to have celiac disease.