Insights from Client Experience with Injection Medroxyprogesterone Acetate (MPA) in India: Lessons from the Field.

Background: The injectable contraceptives have been recently added to the contraceptive basket of Government of India under the National Family Welfare program with the aim to reduce the unmet need of contraception in the country. The present study has been conducted to analyse the continuation rates and concerns among the acceptors of injection MPA. Materials and Methods: The present study was an ambispective observational study conducted in the out-patient department of family welfare division at a tertiary care hospital in New Delhi over a period of 6 months. The study enrolled 483 acceptors of injection MPA who were interviewed in person or telephonically, and a proforma was filled which included the demographic profile, obstetric history of the women, source of information about injection and its timing, number of doses received, side effects experienced and the compliance status. The data obtained was subjected to statistical analysis. Results: The mean age of the studied population was 28.44 ± 4.73 years and average parity was 2. It was found that injection MPA was initiated in the interval period in 304 women (63.3%), post-abortal in 124 (25.8%), and postnatal in 52 (10.8%). The source of information about the injection for most women was health workers (83.5%). Most women (74.3%) were pleased with the injection and showed their willingness to continue, and 67.7% were continuing with the injection at the time of interview. Menstrual irregularity was the most common side effect observed in 48.5% women. Conclusion: The present study showed a good continuation rate of injection MPA for the Indian population. The coverage for this excellent contraceptive modality can be enhanced further if more efforts to disseminate awareness about this method are made. Menstrual irregularity is the most common side effect causing discontinuation which can be mitigated to a significant extent with an effective pre-administration counseling.

The "After Wave": Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 in a series of children from Eastern India.

Background: The objective of the study is to describe the presentation, treatment and outcomes of children with multisystem inflammatory syndrome with COVID-19 (MIS-C) in a tertiary care centre in Eastern India. Methods: Retrospective data of children diagnosed with MIS-C during the SARS CoV-2 pandemic were obtained from hospital records. Clinical details, laboratory profile, treatment protocol and outcomes of children with MIS-C between 01 Nov 2020 and 30 June 2021 were analysed. Results: Ten children (7 males) with a mean age of 6.8 years (median age 5.5 years, interquartile range 3.75-9.5) were analysed. COVID-19 RT-PCR was negative in all patients, whereas the IgG COVID antibody was positive in all children (100%). Seven children (7/10) had a history of contact with SARS CoV-2-positive adults. Five (5/10) children presented with cardiogenic shock. All children had evidence of a hyperinflammatory syndrome. Nine children (9/10) had predominant gastrointestinal and cardiovascular involvement. None had echocardiographic evidence of coronary dilatation or aneurysms either on admission or on follow-up. The elevated neutrophil lymphocyte ratio and D-dimer were found in all patients. All children responded to immunomodulatory treatment. None had residual deficit on discharge or at 4-week follow-up. There was no mortality. Conclusion: Children with MIS-C have good prognosis if early immunomodulatory treatment is instituted. Further prospective studies for long-term outcomes in children with MIS-C are required it being a novel entity recently described.

A quinidine non responsive novel KCNT1 mutation in an Indian infant with epilepsy of infancy with migrating focal seizures.

Epilepsy of infancy with migrating focal seizures {a.k.a malignant migrating partial seizures of infancy (MMPSI)} is an uncommon epileptic encephalopathy with a poor prognosis. Migrating focal seizures with autonomic features, developmental stagnation and refractoriness to treatment are its key features. It is caused by genetic defects in various ion channels, most common being sodium activated potassium channel (KCNT1), found in up to 50% of cases. With advent of genetic diagnosis and precision medicine, many targeted therapies have been identified. Antagonist of KCNT1 coded ion channel like Quinidine has shown promising results in MMPSI. Here we report first mutation proven case of MMPSI from India. This child had a novel heterozygous missense mutation in exon10 of the KCNT1 gene (chr9:138650308; c.808C > C/G (p.Q270E)) which was pathogenic. Neither quinidine nor ketogenic diet could control his seizures. Ultimately, the child succumbed to his illness at nine months of age.

Incidence of thrombocytopenia in the neonatal intensive care unit.

BACKGROUND: Thrombocytopenia is the commonest haematological abnormality encountered in the neonatal intensive care unit (NICU). The incidence in neonates varies greatly, depending upon the population studied. The aim of the present study was to study the incidence of thrombocytopenia in the neonates admitted to the NICU. METHOD: The study was carried out in 258 consecutive eligible neonates from August 2007 to August 2009. Neonates were placed in two risk groups for thrombocytopenia, viz. high risk and low risk, depending upon the presentation, maternal history and any antenatal/perinatal events. Platelet counts were done on the first, third and fifth day of admission and thereafter every 72 hours till counts were normal. Low counts were collaborated with a peripheral blood smear. RESULTS AND CONCLUSION: The overall incidence of thrombocytopenia in the study group was 70% (182/258). The incidence in the high-risk group was 93.7% cases (134/143) and in the low-risk group was 41.7% (48/115). This difference was statistically significant. Factors associated with thrombocytopenia were sepsis, extreme low birth weight, intra-uterine growth restriction, birth asphyxia and pre-eclampsia in mothers. The most common severe bleeding manifestation was pulmonary haemorrhage. The overall mortality in babies with thrombocytopenia was 33% despite > 90% of these cases having received platelet transfusion. Of these pulmonary haemorrhage was the main cause of death in five cases. It is concluded that thrombocytopenia is very common in the NICU and should be actively looked for so that it can be managed appropriately.