Burden of disease and survival rate amongst hospitalized newborns in Himalayan region in North India.

Objective: To describe the patient population, priority diseases, and outcomes in neonates admitted to neonatal unit in the Himalayan region of North India. Study Design: The retrospective study was conducted at a University teaching hospital in Himachal Pradesh, and captured anonymized data on all admissions in newborn unit over 6-year period. Results: Total 12449 newborns were admitted, 4669 were outborn, M:F of 1.35:1 and 81% of them were discharged successfully. Overall admissions surged by 76 percent in six years, preterm admissions increased by 41%. During the same period delivery load grew by 24.7%. Majority 64.9% were full-term; 50.4% (6279/12449) of neonates were low birthweight (LBW; <2.5 kg) and 3.8% were Extreme LBW (ELBW; <1.0 kg). Among intramural, out of 20.2% preterm, 1.8% were <28 week; compared to 1.5% <28 week and 14.1% preterm in extramural. The intrauterine growth restriction rate was 17.6% for intramural and 19.3% for extramural, respectively. The most common morbidities were prematurity (40.2% & 27%), jaundice (32.6% & 27.5%), RDS and respiratory problems (19.2% & 9.8%), sepsis (11.3% & 23.5%), and perinatal asphyxia (6.2% and 7.5%) among inborn and outborn respectively. Total 798 (6.4%) newborns died, 10.5% of all deaths happened within 24 hours; mortality was very high amongst ELBW (110/205, 53.7%) and very preterm infants <28 weeks (81/135,60%). Only 993 inborn and 18 outborn received antenatal corticosteroids, with only 383 inborn and 4 outborn receiving four doses of Dexamethasone. Low gestational age, LBW, less of antenatal corticosteroids, outborns, male sex, and congenital deformity were all found to have a significant association with death (P < 0.001). Conclusion: Preterm accounts for a considerable majority of our total admissions. Greater efforts and investment in better prenatal care, infrastructure, therapeutic facilities, manpower, and periodic training and review of staff nurses are all urgently needed to address the extremely high burden of illnesses and mortality among hospitalized newborns; otherwise, lowering the NMR will remain an unattainable goal.

Pediatric Scrub Typhus Manifesting with Multisystem Inflammatory Syndrome: A New Cause for Confusion or Concern-A Case Series.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has discovered a new disease called multisystem inflammatory syndrome in children (MIS-C). In developing nations, pediatricians must be mindful of the similarities between MIS-C and other tropical fevers such as scrub typhus. Not only should such patients be kept on high alert to rule out tropical diseases and receive appropriate treatment, such as steroids or immunomodulatory medications, but this is also concerning because, if rickettsial or bacterial infection is not detected through cultures and serology, steroid, or immunomodulatory treatment alone can be fatal. How to cite this article: Bhardwaj P, Sood M, Singh R. Pediatric Scrub Typhus Manifesting with Multisystem Inflammatory Syndrome: A New Cause for Confusion or Concern-A Case Series. Indian J Crit Care Med 2022;26(6):723-727.

Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice.

BACKGROUND AND AIMS: Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use. SETTINGS AND DESIGN: This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital. METHODS: All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study. STATISTICAL ANALYSIS USED: Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied. RESULTS: Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years' age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house. CONCLUSIONS: The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.

Joubert Syndrome with Orofacial Digital Features.

Joubert syndrome (JS) is an autosomal recessive inherited disorder characterized by hypotonia, cerebellar vermis hypoplasia, ocular abnormalities (e.g., pigmentary retinopathy, oculomotor apraxia, and nystagmus), renal cysts, and hepatic fibrosis. Respiratory abnormalities, as apnea and hyperpnea, may be present, as well as mental retardation. Since the clinical findings of JS are quite heterogeneous, determination of radiological findings is essential.

Combating Iron Deficiency Anemia among School Going Adolescent Girls in a Hilly State of North India: Effectiveness of Intermittent Versus Daily Administration of Iron Folic Acid Tablets.

BACKGROUND: National surveys in India have documented an increasing number of adolescent girls suffering from anemia. Efforts to build iron stores in adolescent girls will help them improve their prepregnancy hemoglobin level. To assess the effectiveness of school-based supervised weekly, bi-weekly, and daily regimen of iron folic tablets in the treatment of anemia among adolescent girls. METHODS: This randomized clinical trial included 331 anemic school going adolescent girls of Shimla district of North India. Study subjects were randomized to once weekly, bi-weekly, and daily iron folic acid regimen group. An intent-to-treat approach was used to analyze the change in hemoglobin level and serum ferritin levels at the end of the trial period. RESULTS: The rate of change of hemoglobin and serum ferritin levels from baseline to the end of the intervention was found to be similar in all the three groups (P = 0.64 and 0.98 for change in hemoglobin and serum ferritin). Bi-weekly treatment regimen results in comparatively more increase in hemoglobin levels (3.1 g/dl) as compared to once weekly (2.4 g/dl) and daily groups (2.3 g/dl) (ANOVA F statistics = 6.08, P = 0.003). Among the study subjects who reported side effects, more were from daily regimen group (55%) as compared to intermittent regimen group (25% in bi-weekly group; 18% in weekly group; P < 0.001). CONCLUSIONS: In Shimla hills of North India, school-based intermittent iron-folic acid therapy is a feasible and effective intervention for increasing hemoglobin and serum ferritin levels of anemic adolescent girls.

Effects of age and body mass index on peak-expiratory flow rate in Indian population.

Peak expiratory flow rate (PEFR) is a measure of ventilatory capacity measured by peak flow meter. It is regarded as a basic physiological parameter for the diagnosis, follow up and treatment of patients with respiratory illnesses such as asthma, chronic bronchitis, and emphysema. This study establishes the relationship of PEFR with age and BMI in healthy adult males (N=300) of Kumaon region of Uttarakhand. Overall, the mean PEFR is 478.37±68.14. The age is significantly affecting the PEFR unlike BMI. Age as an independent predictor predicts the 72.3% variability (R2 is 72.3%) in PEFR while BMI > 23 as an independent predictor predicts only 1.4% variability (R2 is 0.014). PEFR declines with advancing age due to degenerative changes in musculoskeletal system leading to decrease in respiratory muscle strength. PEFR shows some decline with high BMI in elderly age group.

Hypothyroidism presenting as cardiac tamponade in Down syndrome.

Down syndrome is the commonest chromosomal anomaly. It is often associated with hypothyroidism, which may rarely present with cardiac tamponade as the earliest manifestation and prompt treatment with L-thyroxine is life saving. A six-month-old female child diagnosed as a case of Down syndrome presented with shortness of breathing for last 1 1/2 months. Facial dysmorphism, characteristic of Down syndrome was present. Echocardiography revealed large pericardial effusion and right ventricular diagnostic collapse. A case of Down syndrome with hypothyroidism and cardiac tamponade was kept in mind. She was treated with L-thyroxine and clinical status improved.

Glucose tolerance in overweight and obese North Indian adolescents.

The present analytic study was planned to study the impact of overweight and obesity on glucose tolerance in adolescents. Thirty overweight (BMI analogue ≥ 25-29.9 kg/m(2)) and 30 obese (BMI analogue ≥ 30 kg/m(2)) adolescents were included as cases and 30 healthy age and sex matched adolescents comprised the control group. All the study participants were subjected to oral glucose tolerance test (OGTT) as a measure of glucose tolerance.Means of fasting blood glucose levels in normal, overweight and obese groups were 84.5 mg/dl, 86.7 mg/dl and 94.8 mg/dl respectively. Means of two hourly blood glucose levels in normal, overweight and obese groups were 105.8 mg/dl, 117 mg/dl and 127.1 mg/dl respectively. Oral Glucose tolerance test (OGTT) was normal in all the participants from control group but was impaired in four overweight adolescents. In obese group, OGTT was impaired in eight subjects and one obese child had fasting and 2 hourly blood glucose levels in diabetic range.

Homocystinuria: A rare condition presenting as stroke and megaloblastic anemia.

Homocystinuria is an inborn error of amino acid metabolism in which homocystine accumulates in the blood and produces a slowly evolving clinical syndrome. We are presenting a case of a 4-year-old female child who presented to us with stroke and also had megaloblastic anemia. She was diagnosed as having homocystinuria type-1, and she responded to treatment.