Impact of Anemia on Outcome of HIV-Infected Pediatric Patients: A Prospective Observational Study.

INTRODUCTION: Anemia has been widely reported to predict a poorer prognosis for HIV-infected patients, both in terms of progression to AIDS and in survival. This study aimed to determine the etiology of anemia and its immunological correlation in HIV-infected children. MATERIALS AND METHODS: Four hundred and eighty-nine HIV-infected children were screened, of which 86 HIV-infected children with anemia were enrolled. Standard WHO definitions were used for anemia, HIV staging, and growth parameters. Chi-square test, t-tests, and univariate and multivariate logistic regression analyses were used to analyze the data. RESULTS: Anemia was present in 17.58% (86/489) of HIV-infected children, including 84.6% with moderate anemia, 11.5% with severe anemia, and 2.32% with mild anemia. The mean hemoglobin (Hb) among patients with CD4 count <350 cell/mm3 was lower (7.90 g%) (standard deviation 1.48) compared to those having CD4 >350 cell/mm3 (P = 0.02). Children with severe immunological stage had a significantly lower mean Hb (adjusted estimate: -1.61, 95% confidence interval: -2.65, -0.56) compared to those who had normal immune status. No statistically significant differences in mean Hb at baseline when compared to various demographic and clinical characteristics were observed in unadjusted and adjusted regression models. CONCLUSION: Hb is an easy and inexpensive tool to measure and can be used for monitoring disease progression in a resource-limited setting.

Juvenile Hyaline Fibromatosis- A Rare Autosomal Recessive Disease.

Systemic hyalinosis is inherited as an autosomal recessive disease. It may also be referred to as Fibromatosis hyalinica multiplex juvenilis and Murray-Puretic-Drescher syndrome. A four and a half-year-old female child presented with multiple soft tissue swellings involving the nose, orbital ridges, ears, bony prominences of the ulna and tibia and the parietal and occipital prominence and had gum hypertrophy. The diagnosis of this rare condition was based upon clinicopathological correlation, wherein the histopathological examination of cutaneous lesions reveals accumulation of hyaline material with fibroblast in the dermis. A multidisciplinary approach helped in correct diagnosis, management and in providing counseling for the parents. The child's parents were counseled about the surgical excision of the lesion; however, the parents opted for non-surgical conservative management.

Assessment of safety and immunogenicity of two different lots of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b vaccine manufactured using small and large scale manufacturing process.

BACKGROUND: Hib vaccine can be easily incorporated in EPI vaccination schedule as the immunization schedule of Hib is similar to that of DTP vaccine. To meet the global demand of Hib vaccine, SIIL scaled up the Hib conjugate manufacturing process. This study was conducted in Indian infants to assess and compare the immunogenicity and safety of DTwP-HB+Hib (Pentavac(®)) vaccine of SIIL manufactured at large scale with the 'same vaccine' manufactured at a smaller scale. METHODS: 720 infants aged 6-8 weeks were randomized (2:1 ratio) to receive 0.5 ml of Pentavac(®) vaccine from two different lots one produced at scaled up process and the other at a small scale process. Serum samples obtained before and at one month after the 3rd dose of vaccine from both the groups were tested for IgG antibody response by ELISA and compared to assess non-inferiority. RESULTS: Neither immunological interference nor increased reactogenicity was observed in either of the vaccine groups. All infants developed protective antibody titres to diphtheria, tetanus and Hib disease. For hepatitis B antigen, one child from each group remained sero-negative. The response to pertussis was 88% in large scale group vis-à-vis 87% in small scale group. Non-inferiority was concluded for all five components of the vaccine. No serious adverse event was reported in the study. CONCLUSIONS: The scale up vaccine achieved comparable response in terms of the safety and immunogenicity to small scale vaccine and therefore can be easily incorporated in the routine childhood vaccination programme.

Rational use of blood components - an audit.

OBJECTIVES: The present study was designed to study appropriateness of use of the blood components in pediatric and neonatal wards. DESIGN: It was an observational study conducted in a tertiary care institute. The patients were selected from various pediatric subsections over a period of six months. MATERIALS AND METHODS: All the patients below 12 years of age, who received blood components in any of the pediatric subsections including general pediatric wards, pediatric intensive care unit, pediatric hematology section, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed to decide whether it satisfied the predetermined criteria. RESULTS: Of the total 184 episodes of blood component transfusions, 153 (83.1%) episodes were appropriate and 31 (16.9%) episodes were inappropriate. Among these, fresh frozen plasma transfusions had highest inappropriate [18/41 (58%)] episodes followed by packed red cell transfusions [11/110 (35.5%)] and platelet transfusions [2/5 (6.45%)]. There was no inappropriate episode of cryoprecipitate transfusion. CONCLUSIONS: The present study reinforces the importance of blood audit in the clinical setting. Judicious implementation of guidelines for use of various blood products may help decrease the inappropriate use of blood components.