Effect of Concomitant Tuberculosis Infection on COVID-19 Disease in Children: A Matched, Retrospective Cohort Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has had devastating effects on the health of millions globally. Patients with tuberculosis (TB) are a vulnerable population. There is paucity of data to assess association between the 2 diseases in Pediatric population. OBJECTIVE: To elucidate the effect of concomitant TB on clinical course of pediatric COVID-19 disease. METHODS: Retrospective matched cohort study was conducted at dedicated tertiary COVID-19 hospital in India. All consecutive patients aged <18 y admitted with COVID-19 were line listed. Patients with current or recently diagnosed TB were included. Consecutive age and sex matched COVID-19 patients with no history of TB were included as controls. Medical records were retrieved, clinical data entered in pre-determined proforma. RESULTS: During study period, 327 pediatric COVID-19 patients were admitted. Study group included 17 patients with TB. These patients, tended to be referred from other hospitals, be sicker, had lower SpO2 at arrival and higher severity of COVID-19 as compared to controls (All P < 0.05). They required more mechanical ventilation, had longer length of stay and worse outcome. CONCLUSION: COVID-19 may secondarily affect and modify the course of TB in children. Given the high case fatality rate in this association and potentially treatable nature of TB, attention of the policy makers is drawn to this. NAME OF IEC COMMITTEE: Maulana Azad Medical College and Associated Hospital Institutional Ethics Committee. IEC no: F.1/IEC/MAMC/(80/8/2020/No274). Dated 9 November 2020. TRIAL REGISTRATION: CTRI/2021/02/031197 [Registered on: 10 February 2021].

Estimating the Volume of Equine Rabies Immunoglobulin (eRIG) Required for Local Infiltration in Soft Tissue Animal Bites in Children Using a Wound Size-Based Approach.

INTRODUCTION: Post-exposure prophylaxis using rabies immunoglobulin (RIG) is universal recommendation for category III exposures. This study was conducted to determine quantity of RIG used to infiltrate animal bite wounds in relation to longest dimension and area of wound. METHODS: Children aged 2-18 years reporting within 7 days of category III animal bite were included. eRIG (300 IU/ml) was used in all subjects. A predesigned proforma was filled for clinical and epidemiological details of subjects. Maximum length and width of wounds was measured by using non-stretchable measuring tape. RIG was infiltrated in wounds as per WHO recommendations and volume infiltrated was noted. RESULTS AND CONCLUSION: A total of 100 subjects were enrolled. The mean (±SD) volume of RIG infiltrated in wounds per unit length was 0.75 (±0.21) ml/cm and per unit area was 3.18 (±1.75) ml/cm2. Regression equations were calculated. Proposed equations y = 0.6x + 0.3, where y is the volume of RIG (ml) and x is the length of the wound (cm) and y = 0.9x + 1.1, where y is the volume of RIG (ml) and x is the area of the wound (cm2) can prove to be a useful tool in RIG volume calculation for primary health care providers.

Stool CBNAAT: Alternative tool in the diagnosis of pulmonary tuberculosis in children.

Tuberculosis (TB) remains a significant public health concern, especially in children. The World Health Organization now provides estimates on pediatric TB cases and deaths, underscoring the urgency of addressing this issue. In India, childhood TB contributes significantly to the global burden, with a notable gap between reported cases and estimated incidence. Diagnosing pulmonary TB in children presents challenges, primarily due to difficulties in obtaining suitable respiratory specimens. Rapid tests like Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) have shown promise in enhancing diagnostic sensitivity. Recent research suggests that stool samples offer a non-invasive alternative for diagnosing pulmonary TB in children, with good diagnostic accuracy observed for stool CBNAAT. Furthermore, stool CBNAAT results demonstrate high agreement with gastric aspirate CBNAAT in TB diagnosis. Various stool processing methods, such as centrifugation, filtration, and sedimentation, have shown improved results for CBNAAT testing. However, it is crucial to standardize these methods to ensure consistent and comparable outcomes. Integrating stool CBNAAT into existing diagnostic algorithms for pediatric TB can enhance accuracy and efficiency in diagnosis. When implementing these algorithms, local resources, epidemiological context, and healthcare settings should be taken into account. Stool CBNAAT holds promise for microbiological confirmation of pediatric pulmonary TB, especially in resource-limited settings where obtaining representative respiratory specimens is challenging. Further comparative studies and standardization of stool processing methods are necessary to determine the most suitable approach in different contexts. By doing so, we can make significant strides in improving TB diagnosis and management in children.

Adverse drug reactions in children and adolescents on daily antitubercular regimen: An observational longitudinal study.

OBJECTIVES: Subsequent to introduction of daily fixed dose combination (FDC) regimen with increased dosages and inclusion of ethambutol in continuation phase of antitubercular therapy (ATT) in India, this study was done to evaluate adverse drug reactions (ADRs) in children and adolescents. METHODS: Longitudinal observational study conducted in tertiary teaching hospital. Children (1 month-18 year), with newly diagnosed drug sensitive tuberculosis, started on daily FDC regimen of ATT, were included. Participants were followed up at 2 weeks, 8 weeks and 6 months. Division of AIDS (DAIDS) severity grading and World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality assessment was done. RESULTS: In 99 participants, 29 experienced ADRs. Most commonly ADRs involved hepatobiliary (11.1%) and gastrointestinal (8.1%) systems. Grade 3 severity noted in 35.5% ADRs. Certain causality classified in 19.3%. Presence of ADRs was significantly higher in participants with vs without malnutrition [40.5% vs 21.1% (p = 0.036)]. Tendency for more severe ADRs noted in participants with vs without malnutrition [Grade 3 ADRs out of all ADRs: 64.7% vs 0% (p < 0.001)]. CONCLUSION: Incidence and severity of ADRs has increased after introduction of daily FDC of ATT. Most common ADR observed were hepatobiliary. Malnutrition and less weight for age were risk factors for occurrence and severity of ADRs.

Status Epilepticus in Pediatric patients Severity Score (STEPSS): A clinical score to predict the outcome of status epilepticus in children- a prospective cohort study.

PURPOSE: In adults, the Status Epilepticus Severity Score (STESS), a clinical score, has been shown to be a good predictor of outcome and treatment response. We devised a pediatric modification of this score: the Status Epilepticus in Pediatric patients Severity Score (STEPSS) and evaluated it in children with status epilepticus. METHODS: In this prospective study, children aged 1 month to 18 years presenting with seizure duration ≥ 5 min or actively convulsing to the emergency room were enrolled. STEPSS score was calculated at the time of admission. Outcomes included death, the Pediatric Overall Performance Category (POPC) at discharge and treatment response. The diagnostic utility of the STEPSS score to predict unfavourable outcome was evaluated. RESULTS: One-hundred and forty children (mean age 5.8 years) were enrolled. Seven children died and overall 15 children had an unfavourable outcome. The predictive accuracy of STEPSS at a cut-off of >3: for unfavourable outcome (POPC score ≥ 3) - sensitivity (0.93 [95% CI: 68, 99.8]), specificity (0.81 [95% CI: 0.73, 0.87]), PPV (0.37 [95% CI: 0.22, 0.54]), NPV (0.99 [95% CI: 0.95-1.0]), positive likelihood ratio (4.86), F1 score (0.530); for death - sensitivity (0.86 [95% CI: 0.42, 0.99]), specificity (0.76 [95% CI: 0.68-0.83]), PPV (0.16 [95% CI: 0.06, 0.31]), NPV (0.99 [95% CI: 0.95, 1.0]), F1 score (0.270). CONCLUSIONS: The STEPSS, a simple bedside clinical score, was found to be useful to predict the outcome and treatment response in children with status epilepticus.