Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis.

BACKGROUND: Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. METHODS: In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. RESULTS: The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06-2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05-2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% - 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% - 24.1%) had the highest population attributable fraction for intussusception. CONCLUSION: Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.

Progressive familial intrahepatic cholestasis 3 Camouflaging as Wilson disease in a 12-year-old: a diagnostic Odyssey.

Primary Familial Intrahepatic Cholestasis type 3 is an exceedingly rare genetic cholestatic disorder characterized by the defective hepatocanaliculr bile acid transport leading to progressive liver disease. In this case report, we describe the course of treatment for a 12-year-old kid diagnosed with Wilson disease based on Leipzig score and copper investigations. The child did not improve with chelation therapy and was subsequently genetically classified as PFIC-3. This case highlighted the caveats in Wilson disease diagnostic scoring system. The diagnostic odyssey, therapeutic interventions, and outcome of this case underscore the intricate interplay between clinical suspicion, investigative strategies, and the pivotal role of genetic testing to elucidate rare liver disorders in children.

Intravenous Insulin in Hypertriglyceridemic Pancreatitis.

Hypertriglyceridemia is a rare but significant cause of pancreatitis in children. Hypertriglyceridemic pancreatitis is often correlated with more severity and complications like pancreatic necrosis. Therefore, proper management and prevention of further episodes is essential. The authors report a case of a child with hypertriglyceridemic pancreatitis who was managed with intravenous insulin. According to various case reports and case series, intravenous insulin has been found to be effective in hypertriglyceridemic pancreatitis in adults. Few case reports in children also have mentioned use of intravenous insulin in diabetic ketoacidosis with hypertriglyceridemia. The authors found intravenous insulin to be highly effective in management of pancreatitis due to severe hypertriglyceridemia in the present child.

Efficacy and Safety of Autologous Serum Therapy in Chronic Spontaneous Urticaria in the Pediatric Population: A Prospective Pilot Study.

Background: Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. Objectives: To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. Materials and Methods: All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Results: Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. Conclusion: This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.

Rotavirus Strain Distribution before and after Introducing Rotavirus Vaccine in India.

In April 2016, an indigenous monovalent rotavirus vaccine (Rotavac) was introduced to the National Immunization Program in India. Hospital-based surveillance for acute gastroenteritis was conducted in five sentinel sites from 2012 to 2020 to monitor the vaccine impact on various genotypes and the reduction in rotavirus positivity at each site. Stool samples collected from children under 5 years of age hospitalized with diarrhea were tested for group A rotavirus using a commercial enzyme immunoassay, and rotavirus strains were characterized by RT-PCR. The proportion of diarrhea hospitalizations attributable to rotavirus at the five sites declined from a range of 56-29.4% in pre-vaccine years to 34-12% in post-vaccine years. G1P[8] was the predominant strain in the pre-vaccination period, and G3P[8] was the most common in the post-vaccination period. Circulating patterns varied throughout the study period, and increased proportions of mixed genotypes were detected in the post-vaccination phase. Continuous long-term surveillance is essential to understand the diversity and immuno-epidemiological effects of rotavirus vaccination.

Childhood Intussusception after Introduction of Indigenous Rotavirus Vaccine: Hospital-Based Surveillance Study from Odisha, India.

OBJECTIVE: To study the epidemiology of intussusception in children < 2 y of age, postintroduction of Rotavac® (an indigenous oral rotavirus vaccine). METHODS: A multicenter hospital-based surveillance was conducted in Odisha from February 2016 to June 2019. The cases were diagnosed according to Brighton level-1 criteria. Data were collected regarding the time of onset, signs and symptoms, radiological diagnosis, management, complications, and outcome (discharged/died). RESULTS: One hundred and twenty children < 2 y of age were enrolled. The median age was 7 mo (M:F ratio = 2:1). The most common clinical feature was abdominal distention and blood in stool. The most common method for treatment was hydrostatic/pneumatic reduction. Median time (days) between symptom onset and admission was 2. Median (IQR) duration (days) of hospitalization was 5. Most common location of intussusceptions was ileo-colic. CONCLUSIONS: Hydrostatic/pneumatic reduction was possible in the majority presenting ≤ 48 h of symptom onset, and those presenting > 48 h mostly required surgical reduction. Intestinal resection was required in some cases presenting on day 5 of symptom onset. Majority of cases were managed by surgical reduction in Government facility.

Intussusception after Rotavirus Vaccine Introduction in India.

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).

Pamidronate in Treatment of Calcinosis in Juvenile Dermatomyositis.

Juvenile dermatomyositis is a rare systemic autoimmune disease wth calcinosis as its hallmark sequelae. We report three patients with juvenile dermatomyositis with calcinosis, who were treated with pamidronate. There was complete clearance of calcinosis in one child.

Pityriasis rosea like drug rash - a need to identify the disease in childhood.

Pityriasis rosea is a common dermatosis named by Gibert in 1860. It is an acute self limiting papulosquamous disease, probably infective in origin affecting healthy adolescents and young adults. It is characterized by distinctive skin eruptions and minimal constitutional symptoms. Drug induced pityriasis rosea tend to occur in older generation and resolution seen only after withdrawal of the offending drug. We report a case of 12-year-old boy with erythematous papules distributed over trunk and proximal arms after nimesulide therapy consistent with a clinical diagnosis of atypical pityriasis rosea. The relation of drug and development of pityriasis rosea is confirmed by dechallenge test of the suspected drug.