Risk factors for pneumonia mortality in under-five children in a tertiary care hospital of Darjeeling district of West Bengal: A prospective case-control study.

BACKGROUND: Among children admitted with pneumonia, several modifiable predictors have been identified for deaths in children in hospitals. Despite the presence of a several national programs designed to address most of the risk factors directly or indirectly it is surprising that they continue to be common in children with pneumonia. OBJECTIVES: The objective is to determine the risk factors for pneumonia mortality in under-five children in a tertiary care hospital of Darjeeling district of West Bengal. METHODS: An analytical study with case-control design was conducted between May 2016 and October 2017. Children aged 2-59 months admitted with the diagnosis of pneumonia were followed up after admission and who died were recruited as cases and two consecutive age- and sex-matched controls were recruited among children who were declared cured and discharged. A total of 95 cases and 190 controls were studied and the risk factors were compared in the pair matched groups by the conditional logistic regression. RESULTS: Factors influencing childhood pneumonia mortality were severely underweight (adjusted odds ratio [AOR]: 3.66 [1.28,10.46]) unimmunized child (AOR 4.18 [1.53, 11.41]), lack of exclusive breast feeding (AOR: 3.12 [1.23, 7.91]), past history of diarrhea or acute respiratory infection in the last 3 months (AOR: 7.27 [3.68, 14.36]), hypoxemia on admission (AOR: 2.53 [1.14, 5.61]), sub-center as the first contact health facility (AOR: 6.49 [2.15, 19.67]), and antibiotic not received at first contact (AOR: 3.18 [1.36, 7.43]). CONCLUSIONS: Most of the risk factors for death in children between 6 and 59 months of age are directly or indirectly related to health service delivery and can be ameliorated through proper structural and administrative measures.

Increased interleukin-4 and decreased interferon-γ levels in serum of children with asthma.

BACKGROUND AND PURPOSE: Immune and inflammatory responses, mediated by cytokines, play important roles in the pathophysiology of asthma. These responses are associated with over expression of T helper (Th)-2 cytokine, particularly interleukin (IL)-4 and IL-5, and decreased expression of Th-1 cytokine, IL-2 and IFN-γ. We hypothesized that there would be an imbalance in the levels of circulating IL-4 and IFN-γ in the asthmatic subjects. METHOD: We investigated serum levels of IL-4 and IFN-γ among eighty children (18 steroid-naïve, 30 steroid-treated children with asthma and 32 healthy controls) using commercially available ELISA kits. RESULTS: Serum level of IL-4 was significantly higher in steroid-naïve group of asthmatic children compared to the healthy control subjects and was lower in steroid-treated group though the level was statistically not significant. In contrast, serum levels of IFN-γ were significantly lower in both steroid-naïve and steroid-treated groups of asthmatic children compared to healthy control subjects. CONCLUSION: The results of our study suggest that serum level of IL-4 may be elevated in concert with decreased level of IFN-γ in asthma. Determination of serum levels of IL-4 and IFN-γ may be a useful tool for understanding the disease processes in asthma.

Efficacy of high-dose Lactobacillus rhamnosus GG in controlling acute watery diarrhea in Indian children: a randomized controlled trial.

AIM: To evaluate the effective dose of Lactobacillus rhamnosus GG (LGG) as probiotic in acute watery diarrhea (AWD) in Indian children. SETTING: Hospital-based study. DESIGN: Randomized, controlled, blinded trial. METHODS: All patients of AWD admitted over 1 year were included in the study. They were randomized into 3 groups to receive either only oral rehydration solution (ORS) (group A/control), ORS+LGG powder containing 10(10) colony forming units (CFU) (group B), or ORS+LGG powder containing 10(12) CFU (group C) twice daily for a minimum period of 7 days or until diarrhea stopped along with correction of dehydration. None of them received any other drug such as antibiotic or antidiarrheal medication. The duration and frequency of diarrhea and vomiting were studied. Data were analyzed by SPSS-10 software. RESULTS: The study comprised of 559 patients, group A/controls (n=185), group B (n=188), and group C (n=186). All the groups were similar with respect to age, number of breastfed infants, presentation with dehydration, degree of protein energy malnutrition, and rotavirus infection. The frequency and duration of diarrhea, requirement for intravenous therapy, and hospital stay were significantly lower in both the intervention groups compared with the controls. There was no significant difference between the 2 intervention groups. No complication was observed from the doses of LGG used. CONCLUSIONS: Both the doses of LGG (10(10) and 10(12) CFU) were equally effective to decrease the frequency and duration of diarrhea and reduction in hospital stay in patients of AWD.

Clinico-anthropometric profile of children from Darjeeling tea garden.

OBJECTIVE: To assess clinico-anthropometric profile of hospitalized children and their apparently healthy siblings from the Darjeeling tea garden. METHODS: This was a descriptive, cross-sectional study, done at North Bengal Medical College, West Bengal, India over a period of 6 mo. Consecutively admitted 157 children and their 301 apparently healthy siblings were included. Clinical diagnosis, height/length, weight, BMI were recorded. RESULTS: Children (n = 157) were mostly admitted for gastroenteritis (36.3 %), respiratory infections (26.75 %), meningo-encephalitis (14.0 %). Among 301 siblings, 30.56 % had nutritional anemia, worm infestation, giardiasis etc. Severe (< -3 Z-score) stunting and wasting were noted in 10 (6.37 %) and 19 (12.1 %) hospitalized children respectively. A quarter of all siblings suffered from moderate malnutrition (stunting 24.92 %, wasting 29.57 %). Distribution of malnutrition in each anthropometric parameter was statistically significant (p < 0.05) in sick children compared to non-admitted siblings. Intergroup comparisons for both sexes were statistically significant for all parameters except in length/height for age for females. Moderate malnutrition (< -2 Z-score) was related to low BMI in 45 % (n = 71) of sick and 27 % (n = 83) of apparently well children. CONCLUSIONS: The present study, first of its kind, delineated specific pattern of illness in sick and apparently healthy tea garden children. Malnutrition is statistically significant co-morbid associate in both the groups. Public health policy targeting these children is needed.

Overlap of sturge-weber syndrome and klippel-trenaunay syndrome.

Sturge-Weber syndrome is a rare sporadic condition of mesodermal phakomatosis, characterized by purple-colored flat cutaneous cranial (face) hemangiomas (most commonly along the trigeminal nerve), glaucoma and vascular lesions in the ipsilateral brain and meninges. Klippel-Trenaunay syndrome is also an uncommon mesodermal phakomatosis characterized by a triad of cutaneous and visceral hemangiomas, venous varicosities and soft tissue or bone hypertrophy. Sturge-Weber syndrome in combination with Klippel-Trenaunay syndrome is unusual. Because of the rarity, we report here a 3-year-old boy who presented with overlapping features of both the syndromes.

Effect of Lactobacillus rhamnosus GG in persistent diarrhea in Indian children: a randomized controlled trial.

AIM: To evaluate the role of Lactobacillus rhamnosus GG (LGG) as probiotic in persistent diarrhea (PD) in children of North Bengal, India. SETTING: Hospital-based study. DESIGN: Randomized, double-blind controlled trial. PATIENTS AND METHODS: All patients of PD admitted over a period of 2 years were included in the study as per predefined inclusion criteria. They were randomized to receive oral rehydration solution (ORS) alone, or ORS plus LGG powder containing 60 million cells, twice daily for a minimum period of 7 days or till diarrhea has stopped along with correction of dehydration with ORS and/or intravenous fluids as per WHO protocol and antibiotics in culture positive patients. The duration and frequency of purge and vomiting were studied. Data were analyzed by SPSS-10 software. Statistical significance was calculated by Student t test and chi2 test. RESULTS: The study comprised of 235 patients randomized into 2 groups, cases (117) and controls (118). Both the groups were similar with respect to age, number of breastfed infants, presentation with dehydration, degree of protein energy malnutrition, and distribution of infections. Stool culture was positive in 90 (38.3%) patients, Escherichia coli being the commonest organism followed by Shigella spp. and Clostridium difficile. The mean duration of diarrhea was significantly lower in the cases than in controls (5.3 vs. 9.2 d). The average duration of hospital stay was also significantly lesser in cases. No complication was observed from the dose of LGG used. CONCLUSIONS: LGG (dose of 60 million cells) could decrease the frequency and duration of diarrhea and vomiting and reduced hospital stay in patients of PD.

Efficacy of Lactobacillus rhamnosus GG in acute watery diarrhoea of Indian children: a randomised controlled trial.

AIM: To evaluate the role of Lactobacillus rhamnosus GG (LGG) as probiotic in acute watery diarrhoea (AWD). SETTING: Hospital-based study. DESIGN: Randomised, controlled, blinded trial. PATIENTS AND METHOD: All patients of AWD (n = 684) admitted over 1-year period were invited to participate in the study as per predefined inclusion and exclusion criteria and were randomised to intervention and control groups. After adequate rehydration the intervention group (n = 330) received ORS with probiotic powder containing 60 million cells of LGG, while the control group (n = 332) received ORS alone twice daily for a minimum period of 7 days or till diarrhoea ceased. During the study period all patients received ORS and/or IV fluids for ongoing losses, and nutritional supplementation. None of them received any antibiotic or antidiarrhoeal medication. After exclusion of 16 patients, 646 (323 in each arm) patients completed the study. The daily frequency and total duration of diarrhoea and vomiting and the length of hospital stay were studied. Data were analysed by SPSS-10 software. Statistical significance was calculated by Student's t-test and chi2-test. RESULTS: Rotavirus was isolated in 75.85%. There was no significant difference between treatment groups in the daily frequency or duration of diarrhoea or vomiting or in the length of hospital stay. No complication was observed from the use of LGG. CONCLUSION: LGG supplementation does not decrease the frequency and duration of diarrhoea and vomiting in children with AWD, and does not reduce hospital stay in these patients.