Analysis of Young Infant Deaths Using Verbal Autopsies and Accuracy of Verbal Autopsy Tool in Chennai, India.

OBJECTIVE: To identify medical and non-medical factors associated with young infant deaths using verbal autopsies and to evaluate the validity of state verbal autopsy tool in identifying medical causes. DESIGN: Descriptive study to report factors associated with young infant deaths, and diagnostic accuracy study of the verbal autopsy tool. RESULTS: Prematurity related illnesses were the major contributors to mortality. Deliveries were predominantly in health care facilities (99%); lower maternal education (11.2%), lesser birth spacing (80%), and higher birth order (7.5%) were other factors noted. Verbal autopsy questionnaire had a diagnostic accuracy of ≥95% in identifying major causes of death (kappa value 0.8-1.0). CONCLUSION: Current state verbal autopsy tool is valid in identifying causes of death.

Neonatal Mucormycosis with Gastrointestinal and Cutaneous involvement.

BACKGROUND: Mucormycosis of the gastrointestinal tract is a rare fungal infection of neonates. CASE CHARACTERISTICS: 48-hours-old term neonate presented with intestinal obstruction and perforation. No significant risk factors were present. Histopathological examination of the resected gangrenous bowel revealed mucormycosis. Cutaneous involvement due to systemic spread led to dermal necrosis in toes. OUTCOME: Though cutaneous lesions responded promptly to antifungal therapy, gastrointestinal manifestations required multiple antifungal therapy for prolonged period apart from surgical debridement. MESSAGE: Precise histopathological diagnosis and early appropriate therapy can prevent dismal outcomes in neonatal mucormycosis.

A Novel Protein C Mutation Causing Neonatal Purpura Fulminans.

BACKGROUND: Neonatal purpura fulminans due to congenital protein C deficiency is a rare disorder. CASE CHARACTERISTICS: A four-day-old neonate presented with multiple necrotic skin lesions with abnormal coagulation profile. INTERVENTION AND OUTCOME: Skin lesions responded to repeated plasma transfusions but the neonate developed bilateral retinal detachment. A novel homozygous PROC gene mutation was noted in the neonate. MESSAGE: Molecular diagnosis and prenatal counseling in neonatal purpura fulminans are vital considering the poor outcome.

Epidemiological and clinical profile of hospitalized children with moderate and severe acute malnutrition in South India.

OBJECTIVE: To evaluate the clinico-epidemiological profile, pattern of infections, feeding practices, socio-demographic risk factors and outcome of hospitalized children with moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). METHODS: Cases (children aged 1-60 mo with SAM or MAM) and controls (children with weight for height z score more than -1 SD) were recruited from November 2011 through July 2013. Overall, 126 cases and 126 controls were included. RESULTS: Only 33 % of malnourished children (cases) were exclusively breast fed. Among controls, 71 % were exclusively breast fed for the first 6 mo after birth. Most cases had associated infections (p 0.004) and anemia (p < 0.001). ROC curve revealed 120 mm mid upper arm circumference (MUAC) as the best cut off for predicting SAM. Mothers' education, pre-lacteal feeds and co-morbidities were independent predictors of malnutrition (R(2) = 22.1 %) by logistic regression. CONCLUSIONS: Though 11.5 cm MUAC has been mentioned by WHO as the cut off for identifying SAM, a higher cut off (12 cm) may be required to use it as a screening tool. Mothers' education, pre-lacteal feeds and co-morbidities were found to be independent determinants for malnutrition in the present patient population, indicating the need towards a targeted approach for modifying these factors.