Unique cellular immune signatures of multisystem inflammatory syndrome in children.

The clinical presentation of MIS-C overlaps with other infectious/non-infectious diseases such as acute COVID-19, Kawasaki disease, acute dengue, enteric fever, and systemic lupus erythematosus. We examined the ex-vivo cellular parameters with the aim of distinguishing MIS-C from other syndromes with overlapping clinical presentations. MIS-C children differed from children with non-MIS-C conditions by having increased numbers of naïve CD8+ T cells, naïve, immature and atypical memory B cells and diminished numbers of transitional memory, stem cell memory, central and effector memory CD4+ and CD8+ T cells, classical, activated memory B and plasma cells and monocyte (intermediate and non-classical) and dendritic cell (plasmacytoid and myeloid) subsets. All of the above alterations were significantly reversed at 6-9 months post-recovery in MIS-C. Thus, MIS-C is characterized by a distinct cellular signature that distinguishes it from other syndromes with overlapping clinical presentations. Trial Registration: ClinicalTrials.gov clinicaltrial.gov. No: NCT04844242.

High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial.

Objective: To compare the effectiveness of early high-flow nasal cannula (HFNC) and low-flow oxygen support (LFOS) in children under 5 years with acute hypoxemic respiratory failure (AHRF) due to severe community-acquired pneumonia in low-middle-income countries. Methods: An open-label randomized clinical trial enrolled children aged 2-59 months with AHRF due to severe community-acquired pneumonia and randomized into HFNC and LFOS. In the LFOS group, the patient received cold wall oxygen humidified by bubbling through sterile water administered through simple nasal prongs at a fixed flow rate of 2 L/min. In the HFNC group, the patient received humidified, heated (37 °C), high-flow oxygen at a flow rate assigned based on weight range, with a titratable oxygen fraction. The primary outcome was treatment failure in 72 h (escalating the respiratory support method using any modality other than primary intervention). Results: Data was analyzed intention-to-treat (HFNC = 124; LFOS = 120). Median (IQR) age was 12 (6-20) and 11 (6-27) months, respectively. Treatment failure occurred in a significantly lower proportion in the HFNC group (7.3%, n = 9/124) as compared to the LFOS group (20%, n = 24/120) (relative risk = 0.36, 95% CI 0.18 to 0.75; p = 0.004; adjusted hazard ratio 0.34, 95% CI 0.16 to 0.73; p = 0.006). The intubation rate was significantly lower in the HFNC group (7.3%, n = 9/124 vs. 16.7%, n = 20/120; relative risk = 0.44, 95% CI 0.21 to 0.92, p = 0.023). There were no significant differences noted in other secondary outcomes. No mortality occurred. Conclusion: High-flow nasal cannula oxygen therapy used as early respiratory support in children under 5 years with acute hypoxemic respiratory failure due to severe community-acquired pneumonia was associated with significantly lower treatment failure compared with standard low-flow oxygen support. Trial registration: CTRI/2016/04/006788. Registered 01 April 2016, https://ctri.nic.in/Clinicaltrials/advsearch.php. Supplementary Information: The online version contains supplementary material available at 10.1007/s44253-024-00031-8.

An Interesting and Rare Case of Hemoglobin D-Punjab Variant in Tamil Nadu.

Hemoglobin D (Hb D), a variant of hemoglobin appears in a few Asian individuals belonging to India, Pakistan, Iran, Iraq, and other parts of the world. In India, it is mainly reported in the North-Western states. Hb D disease causes subclinical jaundice, or it may be asymptomatic with pallor in its heterozygous form. Being a country with hunger and poverty, pallor is always attributed to iron deficiency anemia, but one should not miss out on various other causes. Here, we report a rare case of Hb D with iron deficiency anemia in a 13-year-old child of South Indian origin (Tamil Nadu) and emphasize the detailed evaluation of cases with severe pallor. He presented with gradually progressing generalized weakness with easy fatigability for the past four weeks. On examination, he was pale, there was no icterus and systemic examination was normal. Investigation revealed a microcytic hypochromic type of anemia. Hb electrophoresis showed the Hb D-Punjab variant. Iron indices were suggestive of iron deficiency anemia. He was advised iron supplements for three months, and he improved with that. He was counseled about his disease and was advised regular follow-up.

Effect of Light-Emitting Diode Phototherapy on Serum Calcium Levels in Neonates With Jaundice.

BACKGROUND: To assess the change in serum total calcium levels during light-emitting diode phototherapy treatment for jaundice in term neonates. METHODS: A prospective observational study was done on 104 term neonates with hyperbilirubinemia in a tertiary care center to investigate the effects of phototherapy using a light-emitting diode device. The total serum bilirubin along with total calcium levels was measured at the start and at the end of phototherapy. Additionally, all the newborns enrolled in the study were evaluated for hypocalcaemia-related symptoms such as jitteriness, irritability/excitability, lethargy, and convulsions. RESULTS: A significant lowering of posttreatment total calcium level compared to that of pretreatment level (p<0.001) was found in our study. Hypocalcemia (serum calcium <8 mg/dL in term neonates) was found in 12.5% of the study subjects. CONCLUSIONS: In the treatment of neonatal jaundice, similar to conventional blue and white light phototherapy, light-emitting diode phototherapy also has hypocalcemia as an adverse effect. We recommend monitoring these babies for hypocalcemia during light-emitting diode phototherapy.

Utility of wrist circumference in recognition of metabolic syndrome in overweight and obese South Indian children and adolescents.

OBJECTIVE: To describe the utility of wrist circumference in the identification of cardiometabolic risk in overweight and obese children. METHODS: A cross-sectional study was conducted in the obesity clinic of a tertiary care referral hospital over a two year period. All children and adolescents aged 5-17 years with nutritional overweight and obesity were recruited. Data pertaining to chronological age, sex, risk factors and family history were collected. Clinical assessment of anthropometry: Weight, height, body mass index (BMI), Tanner's stage, wrist circumference, blood pressure, waist circumference and triceps skinfold thickness done as per standard criteria. Biochemical assessment of blood glucose, serum insulin, lipid profile, and Homeostatic Model for Insulin Resistance performed after 12 h of fasting. RESULTS: We recruited 118 subjects (mean age 10.9 years, 71.1% males, 87.3% obese and 12.7% overweight); 30 (25.4%) had metabolic syndrome. The mean z scores of wrist circumference of children who presented with and without metabolic syndrome was 2.7 ± 0.8 and 2.1 ± 0.7, respectively (p<0.05). We observed a fair positive correlation between wrist circumference z score and BMI z score, (r=0.5; p<0.05). On receiver operating characteristic curve analysis, 97th percentile of wrist circumference predicted metabolic syndrome among overweight and obese children with a sensitivity of 86.7% and specificity of 37.5% (AUC=0.675). CONCLUSIONS: Wrist circumference with 97th percentile as a cut-off is a useful tool to identify metabolic syndrome amongst overweight and obese children and adolescents.

Type 2 Diabetes Mellitus in Adolescents From Southern India - A Single Center Experience.

This 1-year follow-up study was conducted on 21 subjects with type 2 diabetes mellitus. We found reduction in glycosylated hemoglobin from 10.5% to 8.1%, and maintenance of BMI z-scores from 3.9 to 3.8. Majority of the patients could be weaned-off from insulin. Heterogeneous presentation, frequent co-morbidities and complications, and familial clustering were observed.

Response of South Indian girls with central precocious puberty to gonadotrophin analogue (GnRHa) therapy - a single center experience.

AIM OF THE STUDY: To describe the clinical, auxological, biochemical and radiological response to GnRH analogue in female children with central precocious puberty (CPP). MATERIAL AND METHODS: The data on 22 female children presenting with the larche < 8 years, pubarche < 8 years or menarche < 9 years diagnosed as CPP was collected from the records over a four year period. Assessment included growth parameters, Tanners staging; bone age (BA) by Greulich and Pyle method, ultrasonography of abdomen to assess uterine length and ovarian size and z score derived; biochemical evaluation included serum luteinising hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2); and MRI brain. The children were initiated on injection Leupride 0.9 mg/kg 3 monthly (body weight   30 kg received 22.5 mg). The predicted adult height (PAH) was calculated with Bayley Pinneau method. RESULTS: Treatment was started at the mean chronological age (CA) of 6.09 ±2.1 years and continued till 8.3 ±2.4 years. MRI brain was abnormal in 4 children. Duration of treatment was 2.1 ±0.4 years. The height z scores reduced from 0.5 ±2.4 to 0.18 ±2.4 (p < 0.05). A significant reduction in tanner's stage, uterine size and ovarian volume was observed in the study period. BA/CA ratio reduced from 1.27 ±0.4 to 1.07 ±0.3. PAH z score improved from 1.47 ±1.6 to 0.2 ±2.3 (p < 0.05). CONCLUSIONS: We observed a good clinical and radiological response to GnRHa therapy in girls with CPP and a significant improvement in PAH. Long term follow up is needed to assess the attainment of final height.

Factors influencing growth in children with growth hormone deficiency - a case-control study.

INTRODUCTION: To assess the response of South Indian children with growth hormone deficiency (GHD) to growth hormone therapy, optimal duration of therapy for good catch up, and factors determining the response of our children to growth hormone therapy. MATERIAL AND METHODS: We conducted a case control study at a paediatric endocrine unit of a tertiary paediatric hospital. Children diagnosed with growth hormone deficiency were initiated on GH (cases) or followed up without GH therapy (controls). Detailed clinical, biochemical, radiological, and treatment parameters were recorded at baseline and follow-up. Data were analysed using IBM SPSS version 21. RESULTS: We enrolled 23 subjects in group I (cases who received GH) and group II (controls with untreated children), and both the groups were comparable at baseline. Group I (-4.12 ±1.7 to -2.81 ±1.52) had significant height increase on follow-up after GH therapy compared to group II (-3.55 ±1.7 to -3.51 ±1.52) (p > 0.05). Growth velocity in group I (13.25 ±5.6 cm/year, SD score 4.55 ±5.42) was significantly higher compared to group II (3.4 ±1.8 cm/year, SD score -1.62 ±2.38). Duration of growth hormone therapy, presence of ectopic posterior pituitary, and BA: CA ratio independently impacted the growth velocity SD scores. Kaplan Meier analysis curve showed 15 months of GH therapy was needed to attain a height within ±2 SD of the target height. CONCLUSIONS: Early diagnosis, pre-pubertal status, delayed bone age, and presence of ectopic posterior pituitary on MRI are determinants of a better response. Growth hormone must be administered for at least 15 months for catch up height SDs within target height SD range.

A Study on New IAP 2015 Growth References in Rural South Indian Children.

OBJECTIVES: To ascertain the utility of the new pan Indian 2015 IAP references in rural South Indian children and the ability of new IAP charts to recognise children with abnormal cardiometabolic risk factors in 10 to 16 y age group. METHODS: Among school health camps conducted at two centres of Tamil Nadu- rural Vellore and rural Erode- height, weight, waist circumference, blood pressure, triceps skin-fold thickness and body fat percentage were measured by trained pediatricians and Z-scores calculated. The anthropometric measures were studied as per IAP 2015 references and compared to other national and international references. Their utility in identification of malnutrition and cardiometabolic risk ascertained. RESULTS: A total of 420 children (210 from Erode and 210 from Vellore) in the age group of 10 to 16 y were included in the study. New IAP references recognized more short stature (4.2 vs. 3%), wasting (11 vs. 1.5%) and overweight (14.2 vs. 13.2%) children compared to old IAP charts. The Z-scores of anthropometric measures as per New IAP 2015 references had significant correlation with old IAP and other international data (p < 0.05). It was noted that new IAP charts could detect 83.3%, old IAP chart 50% and WHO 83.3% of subjects with malnutrition. New IAP charts could detect 70.3% cardiometabolic risk associated with over nutrition compared to old IAP (57.4%) and WHO (51.8%). CONCLUSIONS: There is a significant prevalence of both under nutrition and overweight in rural setting. IAP 2015 reference is useful to diagnose children with under nutrition and overweight including abnormal cardiometabolic risk.

Hashimoto's Thyroiditis in South Indian Centre.

OBJECTIVE: To describe the clinical and investigatory profile of children with Hashimoto's thyroiditis (HT) presenting to the thyroid clinic of a referral children's hospital and study the course of children diagnosed as HT over a period of 6 mo. METHODS: Children aged 5-12 y with HT were recruited, their clinical and biochemical details were assessed and were started on standard therapy and followed up for a period of 6 mo. RESULTS: Ninety-seven children (89 goitrous and 8 atrophic form) with mean age: 9.90 ± 1.76 y; M:F 1:5.4 were recruited; 55.7 % were asymptomatic;14.2 % had familial clustering. The mean height, weight and BMI for age Z-scores were -1.0 ± 1.0, -0.8 ± 0.9 and -0.5 ± 1.1 respectively. 16.4 % had short stature; 4.1 % had obesity; 72.2 % had grade 2 goitre. 73.4 %, 13.2 %, 10.3 % and 3.1 % had overt hypothyroidism, sub-clinical hypothyroidism, euthyroidism and hyperthyroidism, respectively. On follow up, 38.5 % of euthyroid and 80 % of sub-clinical hypothyroid children developed overt hypothyroidism. Thyrotoxic symptoms resolved in all three Hashitoxic children by 6 mo. CONCLUSIONS: A female preponderance, less familial clustering, higher paucity of clinical manifestations and quick progression to hypothyroidism (in those without) were noted in the present series.