Cognitive Function in Children With b-Thalassemia Major.

OBJECTIVES: To assess intelligence Quotient (IQ) in transfusion dependent b-thalassemia major patients using Malin Intelligence Scale for Indian Children (MISIC) and to correlate verbal IQ (VIQ), performance IQ (PIQ) and full scale IQ (FSIQ) with serum ferritin levels and annual blood transfusion requirements. METHODS: Cross-sectional study design, enrolling 100 patients of transfusion-dependent b-thalassemia aged 6 years to 15 years 11 months. IQ was assessed using MISIC. RESULTS: Mean (SD) full scale IQ was 95.96 (7.23). IQ was 'average' in most of the patients. There was a significant negative correlation of serum ferritin levels with object assembly (r=-0.215, P=0.034) component of PIQ; annual blood requirement with general comprehension component of VIQ (r=-0.275, P=0.006) and age at diagnosis with PIQ (r=-0.273, P=0.006). There was a significant linear correlation of PIQ (r=0.280, P=0.005) and FSIQ (r=0.274, P=0.006) with pre-transfusion hemoglobin. CONCLUSION: IQ correlates with age at diagnosis and average annual pre-transfusion hemoglobin. This highlights the importance of early diagnosis and maintenance of satisfactory hemoglobin levels.

Evaluation of AIIMS Modified INCLEN Tool for Diagnosis of Epilepsy.

OBJECTIVES: To evaluate the AIIMS Modified INCLEN tool for the diagnosis of epilepsy. METHODS: This cross-sectional study enrolled 250 children aged 1 month to 18 years presenting with complaints of abnormal body movements to either the pediatric or neurology outpatient departments in our institution between October 1, 2018 and June 30, 2020. The All India Institute of Medical Sciences (AIIMS) modified International Clinical Epidemiology Network (INCLEN) diagnostic tool for epilepsy (AIIMS modified INDT-EPI) was administered and a diagnosis was made, which was further verified by a pediatrician or a neurologist. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: The study tool had a sensitivity of 87.6% and specificity of 84.0%. The PPV and NPV of the study tool were 86.8% and 84.9%, respectively. CONCLUSION: The study tool has good psychometric properties for physician assessment with regard to diagnosis of epilepsy.

A phase III randomized, open-label, non-inferiority clinical trial comparing liquid and lyophilized formulations of oral live attenuated human rotavirus vaccine (HRV) in Indian infants.

The human rotavirus vaccine (HRV; Rotarix, GSK) is available as liquid (Liq) and lyophilized (Lyo) formulations, but only Lyo HRV is licensed in India. In this phase III, randomized, open-label trial (NCT02141204), healthy Indian infants aged 6-10 weeks received 2 doses (1 month apart) of either Liq HRV or Lyo HRV. Non-inferiority of Liq HRV compared to Lyo HRV was assessed in terms of geometric mean concentrations (GMCs) of anti-RV immunoglobulin A (IgA), 1-month post-second dose (primary objective). Reactogenicity/safety were also evaluated. Seroconversion was defined as anti-RV IgA antibody concentration ≥20 units [U]/mL in initially seronegative infants (anti-RV IgA antibody concentration <20 U/mL) or ≥2-fold increase compared with pre-vaccination concentration in initially seropositive infants. Of the 451 enrolled infants, 381 (189 in Liq HRV and 192 in Lyo HRV group) were included in the per-protocol set. The GMC ratio (Liq HRV/Lyo HRV) was 0.93 (95% confidence interval [CI]: 0.65-1.34), with the lower limit of the 95% CI reaching ≥0.5, the pre-specified statistical margin for non-inferiority. In the Liq HRV and Lyo HRV groups, 42.9% and 44.3% (baseline) and 71.4% and 73.4% (1-month post-second dose) of infants had anti-RV IgA antibody concentration ≥20 U/mL, and overall seroconversion rates were 54.5% and 50.0%. Incidences of solicited and unsolicited adverse events were similar between groups and no vaccine-related serious adverse events were reported. Liq HRV was non-inferior to Lyo HRV in terms of antibody GMCs and showed similar reactogenicity/safety profiles, supporting the use of Liq HRV in Indian infants.

PLAIN LANGUAGE SUMMARYWhat is the context?Rotavirus is the most common cause of acute gastronenteritis and contributes to the high number of hospitalizations and deaths in young children worldwide.Vaccination against rotavirus has led to a significant decrease in rotavirus-related infections.The human rotavirus vaccine Rotarix (GSK) is currently used as a liquid or lyophilized formulation.In clinical trials conducted in European and North American infants, the liquid vaccine showed ability to induce immune response and safety comparable to the lyophilized formulation.Only the lyophilized vaccine is currently marketed in india.What is new?We compared the 2-dose liquid and lyophilized human rotavirus vaccines in indian infants in a phase III clinical trial:The ability to induce immune response for thw liquid formulation was not inferior to that observed for the lyophilized vaccine.The safety profiles of the 2 formulations were comparable.Why is this important?This study shows that the liquid human rotavirus vaccine can be administrated to infants from india.

Antenatal period: an educational opportunity.

In this study the impact of an educational programme during antenatal period was evaluated. Pregnant women attending the antenatal clinic formed the study material. The first 100 mothers who were not given health education served as controls. The subsequent 201 cases constituted the study group and were given health education on certain aspects of maternal and child care. The control and study groups were well matched for age, parity, education, income and number of antenatal visits. The results indicated that the mothers in study group gained statistically significant knowledge regarding the purpose of antenatal care, hematinics and tetanus toxoid vaccination. The awareness regarding breast feeding and its advantages also increased significantly in the study group. The knowledge about individual vaccine especially measles and DPT was poor which increased significantly after the educational intervention in the study group. It is recommended that the antenatal period should be optimally utilized to impart health education on the various aspects of maternal and child health.

Neonatal conjunctivitis: a profile.

Neonatal conjunctivitis is one of the commonest infections encountered in the newborn. A prospective study was conducted on all babies born over a period of one year. No prophylactic ocular medication was instilled routinely in newborns. Babies developing purulent eye discharge were diagnosed to have conjunctivitis. Eye Swab from the neonates and maternal vaginal/cervical swabs were sent for culture. Chloromycetin eye drops were used for treatment and in case of no response, changed as per sensitivity report or to gentamicin eye drops. Oral erthromycin was given for dacryocystitis or when there was no response to topical therapy. The incidence of conjunctivitis was 7.2%. Two seasonal peaks, namely, February and then May and June, were noted. In 91.6% of the babies, conjunctivitis developed within the first week. A prolonged rupture of membranes was associated with a significantly higher incidence of conjunctivitis (p < 0.01). The most common organism grown from conjunctival swab was Staph aureus (35.2%) followed by Enterococcus (4.3%), Klebsiella (3.5%) and E. coli (2.8%). From vaginal/cervical swabs, E. coli was the most common organism isolated. No concurrence of organisms was noted between eye swabs and vaginal/cervical swabs. A uniformly good response to chloromycetin eye drops was noted with only 3.5% requiring a change of therapy. It is concluded that neonatal conjunctivitis is commonly acquired postnatally and responds well to topical chloromycetin therapy. Oral erythromycin may be used in resistant cases which will cover the chlamydial infection also.

Outcome of hospitalised out-born preterm babies.

PIP: 187 babies born elsewhere and referred to the Pediatric Department of the Christian Medical College and Hospital, Ludhiana, for management of prematurity over a period of 6 years were studied. Babies with hypothermia and those below 1200 g were given iv fluids. Preterm babies delivered in the institution and managed in the neonatal special care nursery over 1 year were also studied for comparison. The preterm babies were evenly distributed in the different gestation age groups between 28 and 36 weeks. About half the babies were appropriate for gestational age, while 47% were small for gestational age. The weight ranged from 760 to 2260 g. Males (166) outnumbered females (21) by a ratio of 8:1. There was a high incidence of hypothermia (54%) at the time of admission, more so in babies with gross prematurity. In babies less than 30 weeks old, 80% had become hypothermic during transit to the hospital. A fatal outcome was seen in 69% of babies with hypothermia as compared to 38% of babies admitted without hypothermia. 85% of babies were born in circumstances of potential infection in the form of prolonged rupture of membranes, multiple unsterile vaginal examinations, foul smelling liquor, fever of the mother, or a combination of these. Septicemia, purulent meningitis, bronchopneumonia, and diarrhea were the common infections. Other common morbidities were hyaline membrane disease, necrotizing enterocolitis, and metabolic disturbances. The overall mortality was 54% and it was inversely proportional to the gestational age, increasing from 36% at 35-36 weeks to 82% at 28-30 weeks. On the other hand, there was only a 21% mortality rate among preterm babies delivered at the hospital and managed in the neonatal nursery. Mortality was 9% in babies at 35-36 weeks. Intracranial hemorrhage was the most common cause of death in the study group, accounting for 42% of total deaths (59% of deaths at 28-30 weeks gestation, decreasing to only 4% at 35-36 weeks), followed by septicemia in 31%. On the other hand, septicemia caused about one-third of deaths at 35-36 weeks.^ieng

Meningococcal disease in Canada: surveillance summary to 1987.

Meningococcal disease continues to occur in most parts of Canada at endemic levels, with minor fluctuations. The incidence in general has changed very little over the past three decades. It is primarily a childhood infection, occurring most commonly among infants less than 1 year of age. In 1987 the risk of infection among infants in that age group was 4 times and among those aged 1 to 4 years 2.5 times that of the general population. The most susceptible appear to be infants about 3 months of age. The annual CFRs had exceeded 50% before the antibiotic era, but with early diagnosis, modern therapy and supportive measures they have been less than 10%. A revised form for reporting cases, currently being considered by provincial epidemiologists across Canada, could help to provide more clinical and epidemiologic information.

Eradication of indigenous poliomyelitis in Canada: impact of immunization strategies.

During the period 1950-1954, surveillance for paralytic poliomyelitis in Canada revealed an average of 1,914 cases (13.2 cases per 100,000) annually. The licensing and widespread use of inactivated poliovirus vaccine (IPV) in 1955 coincided with a marked decline in disease rates. Due to incomplete vaccine coverage of the population, a resurgence began in 1958 and peaked in 1959, despite an observed vaccine efficacy of 96% for 3 doses of IPV. The introduction and widespread use of oral poliovirus vaccine (OPV) started in 1960 and coincided with a decline in disease rates. Virtual elimination of the natural disease was achieved in the 1970s in all provinces regardless of the specific immunization program chosen (IPV or OPV alone or combined). From 1965 to 1988, 51 cases of paralytic poliomyelitis were reported in Canada. Thirty-five of these cases, all but one occurring before 1980, were attributed to wild virus infection, (14 caused by imported virus and 21 assumed to be endemic). Sixteen cases were OPV-associated: 4 in vaccine recipients and 12 in contacts of OPV recipients. Vaccine-associated paralysis in recipients and contacts occurred at the rate of one case per 9.5 million and 3.2 million vaccine doses distributed, respectively. The risk of paralysis attributable to OPV therefore is small compared to the overall benefit of the vaccine. Both IPV and OPV appear equally effective, and theoretically, a combination of the two (IPV followed by OPV) provides the best risk benefit ratio. Occasional exposure of the Canadian population to imported wild virus requires that high levels of population immunity be maintained.

Meningococcal disease in Canada. Surveillance summary to 1987.

Meningococcal disease continues to occur in Canada at endemic levels, with minor fluctuations. The incidence of the disease, in general, has changed very little over the past 3 decades.